Elevating the Delivery of Chiropractic

The principles of chiropractic have been taught by committed, determined individuals and professional organizations for more than 100 years. In fact, because of that commitment and determination, the term chiropractic has become a household word today. Millions of people seek chiropractic care as an anecdote for their ills, cricks and strains. But are those the true principles chiropractic was founded upon?

When B.J. Palmer practiced, he would take X-rays, confer with medical doctors to evaluate the patient's level of health, have the patient perform extensive strengthening rehab, adjust them only when their condition required, take post-therapy X-rays to evaluate structural changes, and then have the medical doctors re-evaluate the patient to determine objective changes in health. B.J. writes about this process in Green Books. We have been at this game of spreading the word of chiropractic for about 107 years now. Let's check our progress.

I was presented recently with an article that discussed the progression of chiropractic and health care in the U.S. Roughly 10 years ago, more than 6 percent of the population went to chiropractors regularly. Since then, the American population spends more money out-of-pocket than ever for health care, choosing to seek "alternative health care" providers. The amount of money the American public spends on alternative health care also has increased. It is obvious there is a general shift in consciousness of the general public toward health care as opposed to the disease care model provided by allopathic/conventional medicine.

Despite these trends, the number of people who have gone to see chiropractors regularly has declined. What happened? Are we not getting the message out, or is it possible the public still doesn't quite understand what we do? As a chiropractor who has always strived to teach the principles of chiropractic and provide the best structural corrective care for patients, I have an opinion on why this perplexing and frustrating condition exists.

In 2004, Newsweek magazine printed an article on chiropractic care. It found that "while experts generally agree that the treatment, which involves manipulation and stretching, is safe for the lower back, there is not a lot of data on how effective it is in the long term."

According to a University of Wisconsin study regarding chiropractic and its effectiveness in treating low back pain, including the use of spinal manipulative therapy (SMT), "There is moderate evidence of short-term efficacy of SMT in the treatment of acute low back pain," but no evidence it was more effective than other physiotherapeutic applications, such as massage or drug therapies, including analgesics or NSAIDs.

That information feels like a direct "gutshot" to our profession. In fact, it hurts so much that you may be objecting to the fact this information exists online, capable of being seen by any potential chiropractic patient today. However, the fact remains that there are numerous studies to show chiropractic is very effective in the short-term relief of acute low back pain, but there are no long-term studies showing it is any better than other treatments (e.g., massage or drugs).

Now that we are in the information age, we are taking care of a different kind of patient. Patients are now finding information before they visit your office by using the Internet. If they conclude from studies such as these that there is no difference between going to see a chiropractor and getting their neck "cracked" or their back "rubbed," which will they prefer? I guess the ACA article already answered that question.

Studies also show that traditional physical therapy isn't effective, and even medical doctors know their treatment for low back pain is failing. In spite of this, why are patients not choosing chiropractic as frequently as they used to? In an era in which consumers are increasingly interested in alternative health care, why isn't chiropractic care growing? With more and more people acknowledging that a prescription for a drug is not the solution to what ails them, why aren't more seeking chiropractic care?

And what about the philosophy of a healthy spine equals a healthy body? Isn't that the premise chiropractic was founded on? We have been teaching chiropractic as a lifestyle choice for 107 years and we have not even reached critical mass, which is only 11 percent of the population. Dentists reached critical mass and educated the American public in 40 years - and people don't even like going to the dentist. We have gotten worse results than they have. What are we missing? How can we elevate the impression and delivery of chiropractic care in this country?

The purpose of this article is to help you realize something needs to change if we are going to create a bigger and more inspirational impact on the general consciousness of the public toward chiropractic and the health of the spine. Don't get me wrong: If we do what we need to do, the future of chiropractic is still very bright. But something has to change.

I believe the reason there are no long-term studies showing greater efficacy in chiropractic long-term care is because, as a profession, we are not really correcting the cause of the patient's problem: subluxation and structural weakness of the spine. Pathology begins with structural misalignment of the spine that leads to neurological and physiological deficit. An adjustment is a proprioceptive input to the body and brain that can stimulate an autonomic response in the nervous system, which can then affect organ function. This stimulation is noticeable in changes in heart rate, blood pressure, etc. Putting motion into a spinal area also can relieve the inflammation causing pain. When inflammation is gone, pain is gone.

If you haven't educated your patient on the chiropractic principle of "healthy spine, healthy body," the patient is already gone. The inflammation/pain cycle is why there is an abundance of studies supporting the effectiveness of spinal manipulation and its short-term efficacy with acute low back pain. Again, what is the cause? The cause is the loss of the optimal structure and function of the spine, leading to the progressive physiologic breakdown of the body.

We have prided ourselves on being doctors of cause, yet we have little training on how to actually correct subluxations or achieve predictable structural correction of the spine. Sure, we learn how to mobilize the spine, but is that actually achieving structural correction and curve restoration? I believe this is the basic underlying reason why the research shows no long-term evidence of more permanent correction of low back pain; generally speaking, we never "fixed" anything. Can you blame the general public for its impression of our profession?

Research also indicates the average chiropractic patient has seen six chiropractors. If we take X-rays of a patient who has been to several other chiropractors, what would their spinal structure look like? How many of those chiropractors told them they would "fix it"? Who is finally going to take responsibility to correct them? Maybe it's actually time we did what we told patients we were going to do.

When we look at the trends in spinal rehabilitation and correction, adjustment-only practices are not going to see consistent structural changes on post-X-ray. You will see some changes, but I am talking about consistent and predictable change. In fact, research shows that rehabilitation and strengthening are the keys to spinal rehabilitation. Today, it is common knowledge that strengthening exercises are essential to achieve long-term relief of low back pain. Insurance companies demand active rehab during corrective care or they will cut your reimbursement. Medical doctors, therapists, insurance companies, hospitals, workers' compensation, etc., know strengthening rehab is the key to spinal stabilization.

In more than a fourth of U.S. states, a chiropractic patient may not be covered through workers' compensation if the patient is not doing active rehab to strengthen the spine. This is where the trend is moving. Insurance companies will pay for rehab more than they will pay for adjustments. Since muscles support curves and spinal structure, spinal rehab is the key to attaining more permanent structural correction and strengthening of the spine.

Traditional rehab can strengthen the spine, but typically doesn't achieve structural correction. This may be part of the reason insurance companies will pay for functional loss and strengthening, but not curve correction. What if we could provide them with a rehab protocol that could restore function and achieve structural correction to show improvements in the overall health of patients? Isn't that where B.J. started 70 years ago?

Let's look at traditional rehab versus rehab for spinal structural correction. In traditional rehab, as performed by most chiropractors, physical therapists, hospitals, etc., the patient performs kinetic exercises against a resistance, such as exercise bands, exercise balls, or via weight or resistance training, through a range of motion. This type of strengthening exercise works the fast-twitch muscle fibers. As I have stated in a previous article, that type of strengthening will help you lift your groceries, but it will not change spinal structure. Your spine will continue to progressively degenerate while you are flexing your biceps on the beach in the summer.

Spinal structure is controlled by slow-twitch, postural muscles. These muscles demand isometric exercises. Again, since muscles support curves, a chiropractor should be able to look at an X-ray, determine where the soft tissues are not supporting the abnormal spinal structure and implement a rehabilitative protocol to strengthen those muscles, support the curves and achieve predictable and more permanent correction of the spine.

How does adjusting the spine fit in? Spinal adjusting provides the induction of motion and the proprioceptive input into the cerebellum that initiates the structural change and autonomic response to help heal the body. The isometric exercises following the adjustment help to support the spinal structure to hold the adjustment so the body can achieve more permanent curve correction and healing. As you may have experienced, spinal adjusting alone will not achieve predictable correction; otherwise, every chiropractor would be achieving that result. We know that is not the case.

Maybe if we, as a profession, could achieve predictable and more permanent correction of the spine, and if we could teach our patients the home care exercises to maintain that structure, the research regarding the efficacy of chiropractic care for long-term results would start to change. I urge you to take responsibility for the lives of your patients and the future of this profession.