50 Years Ago This Month

Years ago, I remember hearing about doctors who were in practice for 50 years and saying to myself, "Not me!" Well, I have been in practice that long as of February 2009. After 50 years, I can absolutely state that I never would have wanted to be anything but a doctor of chiropractic. Chiropractic has given me the opportunity to maintain an open mind in a wonderful drugless method of health care.

I have always been a skeptical individual, which I realize has its pros and cons. Some of my religious friends get upset with my agnostic attitude toward almost everything. I had a difficult time in chiropractic college (kicked out of the class several times) because I was not able to accept some of the "principles" that were constantly being expressed. My first few years in practice were extremely difficult because I never felt fully comfortable about what I was doing. Finally, after 50 years, I feel more comfortable with my ability to care for patients, but I am cursed with a perpetual frustration. My frustration is that not all of my patients get well. I suppose we all have to accept this inevitability. In many cases, however, if we understood more, we may have succeeded in helping them more of the time.

I have never been comfortable with the idea that adjusting the spine is all that is necessary. Mind you, I certainly adjust the spine. I went to the Gonstead Clinic about 21 times with my good Gonstead friend, Dr. Sheldon Delman. I think I have converted him somewhat about the world of soft tissue, but he is still somewhat of a hard sell. I still think the Gonstead knee-chest table is the best chiropractic table ever discovered. Unfortunately, few of our colleges use this versatile table.

For years, I was under the impression that the spinal adjustment was all that was needed for most spinal pain and even most extremity problems. As we learn more and more about the physiological effects of our chiropractic adjustment, I have become ever more enthused with its efficacy. But I also have become enthused with soft-tissue methods. Back at old Lincoln Chiropractic College, I learned that to treat a shoulder, all I needed to do was make sure C5/C6 were not subluxated, use joint play for the shoulder and administer ultrasound. Some of my patients got well. But many did not and I didn't understand why.

My eternal frustration led me first to a receptor tonus course by Raymond Nimmo. Next, I sat in a three-day course given by a PT who worked along with James Cyriax, MD, who supervised an orthopedic clinic in England. This course temporarily reduced some of my frustration. I realized for the first time the magnificent possibilities of using soft-tissue methods on the human frame. I have applied this information to many soft-tissue courses ever since.

During one of my lectures at a college many years ago, a student asked if I ever treated a patient and did not give them an adjustment. I realized at that moment that if I said yes, the students would be disappointed. I answered that I adjusted practically all of my patients, but there were times when I did not adjust them. My question back to the student was, why do you adjust patients on the day you discharge them from care? If you deliver an adjustment, you must have found an area of the spine that needed to be treated, so logically they should return for another visit so that area could be evaluated.

It seems to me that on the day a patient is discharged, they should not need to be adjusted. Some argue that everyone always needs to be adjusted (possibly weekly or biweekly) since we live with perpetual subluxations that are detrimental to our health. To date, there is no evidence I know of that validates this premise.

After 50 years of practice, I am saddened that our profession is not at the forefront of drugless healing, or at least at the forefront of being the spinal doctor of choice. We already are the established experts of manipulative healing for the spine and extremities but unfortunately, we make up most of the population that knows this. Some in our profession want us to just be spinal doctors. It appears that the public already accepts us as spinal doctors - and where has it gotten us? We treat less than 10 percent of the general public after more than 100 years. The literature is replete with the value of manipulation, but the complete package requires more than "just adjusting" for better outcomes. If spinal manipulation/adjustment were really that potent, why are we not seeing a greater segment of the back pain public?

Our results are at least as good as, or maybe better than, most treatment methods, but not really that spectacular. We have left out an important component. A key to our future is to combine spinal adjusting/manipulation with complete soft-tissue evaluation, treatment and rehabilitation. Will we ever accept the fact that the spine is a passive structure moved by muscles and supported by connective tissue? We should be using soft-tissue evaluation and treatment not only for its relation to the spine, but also for extremity problems and the whole kinetic chain. It appears that shoulder complaints are the second most common complaint in a chiropractor's office. A supermarket always attracts more people than a one-item store. In order to be the complete drugless package for most neuro, muscular and skeletal conditions, we must be able to evaluate and treat the entire package.

I am disappointed with how soft-tissue evaluation and the many aspects of soft-tissue treatment are taught in our colleges. There is increasing literature demonstrating the positive effects of directed mechanical load on soft-tissue areas all over the body. There are other reasons why our profession is not serving a greater percentage of the population, but a missing link has to be related to our methods in helping patients to get well. Comparing our profession to a sports team, we have to out-treat our competitors. There are still too many in the field educated with old notions that retard our progress. Is it too late? I will let you know at my 100th anniversary.