Now (and I am being very serious now) although you may read this as provocation or me just generally messing around it is really not intended as such. It is just my view, just my understanding, and if you think there is something wrong with it, then I’d love to know. If you have knowledge of some detail which would generally blow the view out of the water; PLEASE let me know. I don’t want to live in ignorance any longer!
So, in no particular order:
- A chiropractor is someone who removes subluxations.
- If removing the subluxation is what a chiropractor does, then it is only fair that we are clear about what a subluxation is.
- Without subluxation, chiropractic does not exist. Without subluxation there is nothing to adjust.
- Without subluxation the person looking like the closest thing to a chiropractor is someone who manipulates fixated joints.
- The difference between a chiropractor and a medipractor is that the chiropractor adjusts the subluxation, the medipractor frees the fixation
If there is anything wrong with the above statements; PLEASE LET ME KNOW!
I know there are many opinions on what the subluxation concept represents and I have read some of the literature talking seriously and some of it waxing lyrically about it. I have looked at its history and have looked at its present, and something struck me all along: it actually all makes a hell of a lot of sense… When you look at it in a certain way. This is the story of how subluxation came to make perfect sense to me.
Thing is I possibly be deemed to have an unfair advantage; I also was raised not thinking that there were only spinal subluxations. I was raised chiropractically with the triune of health; emotional, chemical and physical well-being and all that. Which made a lot of sense and remained in context when I read things like the words vertebral subluxation concept, which at the time left me assuming there were indeed other, non-vertebral subluxations. Great was my surprise that the differentiation does not seem to be commonly made… So, in the meanwhile, I laboured on with the assumption that it was clear that there were other types of subluxations too. Subluxations which were to be found in the chemico-nutritional arena, and the psycho-emotional arena, forming a pretty ven-diagram of subluxations with overlapping arenas like “hormonal function” and “psychomorphology” and so on. Physical subluxation contained amongst others vertebral subluxations. It all made sense that there would be many types of subluxations, some of which could be removed by chiropractors, most of which wouldn’t. It made sense as witnessed by the presence of many healing arts, each with different methodologies, all aiming to improve the person’s well-being by raising their ability to cope or by decreasing the stress, perceived or real, ultimately resulting in a restoration of well-being and health. Whether a surgeon removing a tumor surgically, a GP killing off a bacterial infection with antibiotics, a councillor teaching a person coping strategies or a podiatrist improving the person’s gait; they were all adjusting subluxations. Life was simple; we are all adjusting subluxations… I came to conclude Chiropractors like you and me were in fact “spinal chiropractors”, but that there were lots of other people removing subluxations. A subluxation came to mean a dysfunctional mechanism causing an increase in damage rate or a decrease in healing rate.
If we take ill-health to be the end result of a negative mismatch between the rate at which one is destroying tissue and rate at which one is repairing tissue, then I had to ask myself the following question as a differentiator: is the subluxation that which causes a reduction in the healing rate or that which causes an increase in the damage rate? Classic chiropractic literature would have it that the subluxation is that which impinges on “Innate Intelligence”. So I took it to be the former of the two we are talking about: the reduction in the healing rate. Now there was an issue with this: It would come to mean that the injury itself was not of any relevance to me as a chiropractor. What was of relevance would be the ability to restore health. Man has car accident. Man hurts neck. Man still has a hurting neck after 6 months, ergo: man has reduced ability to heal. Man has subluxation. Find subluxation. Remove subluxation. Man increases ability to heal and restores health and well-being. Miracle of life occured. Thank you chiropractor.There was a problem with this: not everone I saw had a problem with their ability to heal. They were just damaging themselves so rapidly that it exceeded their ability to heal, despite the fact that to all intents and purposes they had good healing capacity. I saw this a lot. So the subluxation had to be more than a reduction in healing rate. It had to be the cause of a negative mismatch between healing rate and damage rate.
So I started to think of it as “that which causes a reduction in healing rate or increase in damage rate resulting in a negative progression with eventual outcome of symptomatic display”. It meant there were two types of subluxations: Healing rate suppressing ones and Damage rate increasing ones. HRS and DRS. Remember that I still thought of it as a multi-professional occupation to look at subluxations. Nutritionists for example seem to be primarily concerned with HRS’s, whilst dieticians could be argued to be looking at DRS’s by means of reduction of physical (and emotional, not to mention physiological) stresses.
I, as a chiropractor, by this stage started to see that there were low-stress movement patterns and higher-stress movement patterns. Patients displaying high-stress movement patterns were doing so for a number of reasons. I started to see correlations with a lot of chiropractic techniques. They were all just about pressing buttons which would ultimately lead to a change in movement patterns. These high-stress smovement patterns could have physical causes, emotional causes, chemical causes. Because I am a chiropractor and the public’s perception and understanding of what I do (treat back pain) and because I am human and could only contain so much information, I consciously limited myself to the physical end of the causal spectrum. As time went on I looked at physical causation of abnormal movement patterns to be my thing and had lots of fun doing just that. I got good at identifying when the pain people were presenting with was a pain which was largely, partially or not at all caused by such physical causes of abnormal movement patterns. I accepted those patients where pain was largely due to dysfunctional movement patterns of physical causation and rejected (and duly referred or advised according to my evaluation of the situation). Patients were really happy with that and the street-cred steadily grew.
What this also meant is that I consequently started to look at diagnoses like whiplash and sciatica in a very different way: OK, you hurt your back/neck, I understand that. Is it reasonable for you to still be hurting or be hurting at all from this action and after this time? I still gave things a name, a diagnosis, but this became my biggest question in consequence. I found this was very much what chiropractic philosophy had been banging on about all this time. I stopped looking for just the clinical diagnosis, … I now had to figure out a causal diagnosis. I had to give reason to why 6 months after the accident this man was still hurting, I had to figure out why this lady so badly hurt her back just bending to pick of a paper. It just wasn’t reasonable for it to be like this. Evolution surely could not allow for such simple things to have such grand consequences? Or was it just that we are in fact coping really well but we are just asking too much? Maybe it is not natural to move in a metal box at 70 miles/hour, crash and expect to come out unscathed? Or live comfortably untill we are 70 years of age and over? I started thinking that it was quite interesting to note that back pain epidemiology seems to concur with the expiring of procreational usefulness. As so many things do… The other thing that was nice to notice was that it seemed to be obvious to my patients and they had no problem with me changing their expectations. Not surprisingly really, their expectations had been disappointed before and my version of things just seemed far more logical than attributing pain to a lack of painkillers or anti-inflammatories (which in my opinion have a place).
So I decided that chiropractic care is all about artificially reversing natural decay by increasing ability to cope and reducing excessive and unnecessary stress levels: If innate intelligence takes hold when the rate at which one heals is greater than the rate at which one damages. It seemed to fit classic chiropractic philosophy and literature just so. Health would be the end-result of a positive ratio. I couldn’t find anything to disagree with it. So now “subluxation” came to mean anything which reduces healing rate or increases damage rate. And anyone adjusting subluxations was a chiropractor. I was in deep trouble… Then I realised that DD was maybe so far ahead of his time that he had actually accidentally divined a fantastic model of integrated healthcare. He just didn’t know it and had other priorities on his mind. To give him due credit: an appreciation of the state of affairs at the time would forgive him for being overly focused on spinal events. I also understand that that HIO-concept came about as a highly reductionist exercise, but only later.
Then, because I was now starting to think in terms of paradigms, I also realised that there were other paradigms, which although similar on occasion could on others be widely different. Giving antibiotics in someone who has no chance to recover is one thing, giving them because there is an infection is yet another. I saw a way out of my logical nightmare: it’s never was a case of “either or” in the first place, just “as and when appropriate”. The confusing thing was that certain healthcare professions seemed to be having paradigms which should logically mean others couldn’t be true or at best stood less of a chance to hold water. Then I realised that the solution was far simpler: It is one and only one healthcare spectrum-continuum allright, and all paradigms would fit neatly next to one-another, but the parameters hadn’t been identified clearly for starters, so no wonder people weren’t seeing where they fitted in!
And again,… the parameters were provided by chiropractic philosophy and its integrative nature… intrigued? (I will be pleased if you haven’t fallen asleep yet) I figured that if we look at the axis (visualise standard X-axis) rated from 0-10 and the number is representative of “the ability to cope”, which in itself is a ratio of healing rate over damage rate (this in turn is an X-Y axis). Point is that where healing rate is significantly over damage rate, the person is best left alone and really does not need anything other than possibly time and painkilling medication to improve quality of life. At the other end of the spectrum so much damage is being done that it is necessary to intervene high-level: surgically and pharmacologically. Ergo: hugs at one end, scalpels at the other. This made perfect sense, chiropractic was slap bang in the middle, exactly the way patients felt with nowhere to turn to. Medication wasn’t helping anymore and surgeons wouldn’t do anything. It also made sense from the lyrical literature and the mythical sayings of the oldskool; find it, fix it, leave it alone. There had to be something before you could “find it”, you had to be able to “fix it” and then let nature do what it does best: look after itself. So many sayings, so little time…
So I thought I had identified that there is this axis, I had decided that it is built up out not one but three lines (chemical, physical and psychological) which interact with each-other and that spinal manipulative therapy would be part of the middle section of the “physical line”. This spinal manipulative therapy lark started to look rather underwhelming… I had to increase my scope of practice (in terms of dysfunctional movement patterns I could address, rather than symptoms I could relieve) for it to be worth my while. I started to look for more subluxations to adjust so I could help more people achieve better results. I quickly found that there were plenty of people having problems with their gait and lots of people having problems with their bite. I found ways to deal with these and made people better at a fantastic rate. Overall costs of treatment dropped, outcomes improved, street-cred went up another notch.
So, in my mind, I am a biomechanical chiropractor. There are other chiropractors out there who adjust mental and chemical subluxations, but I adjust physical subluxations. Sometimes I don’t adjust them myself but I ask people to do it for me. People who are far better at that stuff than me and who I trust implicitly to deliver the goods. Podiatrists, dentists to name a few of those other biomechanical subluxation adjusters I work with regularly.
Would I like to be a complete chiropractor? Hell yeah, but I also know it just ain’t gonna happen (not in my understanding of chiropractic anyway). And I guess that leads me onto my conclusion: the polarisation of chiropractic is really one of one camp wanting to be a complete chiropractor but not willing to see their own limits and on the other hand people wanting to reduce it all to spinal manipulation and not seeing how pointless and un-chiropractic that is. And that brings me to the end of my little adventure. I also think it should just be reiterated, for clarity sake, that I don’t see chiropractic as replacing anything, So I never understood the why of chiropractic being “alternative”. Chiropractic is in my understanding an all-encompassing paradigm, which allows for and recognises value to all parts of that paradigmal spectrum. GP’s sit on that spectrum, surgeons, aromatherapists and barbers, we are all part of the spectrum, and better play a good part if we want it to be meaningful. These are some of the conclusions I have come to and some of the reasons why chiropractic in its original form is not only beautiful, logical and very effective, it is also the healthcare of the future and as I see it goes far beyond cracking backs. A future where all manner of subluxations are adjusted by all manner of chiropractors. Some will be adjusting mindsets, some will be adjusting your food, some will be adjusting your feet and some will be adjusting your spine. Some will tell you it’s OK, you can cope and don’t need anyone else or some will need to pump you full of drugs to give you a chance for life. I like what I do, and that is chiropractic.
Many kind regards,
Thanks DD. I might be giving you too much credit, but somehow a grocer from Iowa would be just the man to come up with the most complete healthcare paradigm in existence. Just a shame so many people had to go and mess around with it … Or is it?
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