By Donald K. Moon, D. C.
Vol. 3, No.9, January, 1985
Strange title for a chiropractic article you say? Particularly strange when our profession is gaining acceptance by leaps and bounds? Certainly chiropractic has in purely legalistic terms become a recognized entity in the health care field. With that recognition has come a form of acceptance by both the medical and public communities.
The question is, will chiropractic be accepted as a separate health profession with a sound scientific foundation or will it be accepted as a system of therapeutics with no sound proven principles upon which to base its claim of individuality? lf there is no basis for our premise that we offer an innovative, preventive and corrective approach to health care, then the prospect of absorption into the medical community will be very real.
Perhaps there are those in our profession who see this possibility as a plus in order to gain so-called “acceptance.” It appears to some chiropractors and yes, even those in our educational community would blur the lines between medicine and chiropractic.
In talking to recent graduates of chiropractic colleges, I frequently ask them the questions: What is the role of chiropractic in the scientific community and what is it that allows chiropractic to exist as a separate profession? Disturbingly, a great percentage never mention the vertebral subluxation or the subluxation complex. They appeared unsure of where they truly fit into the health care field. The emphasis of their education appears to have been on the subject of diagnosis; so much concentration in fact on diagnosis that little time has been spent on the misalignment factor and its scientific reduction. If this trend continues one cannot help but wonder about the future role of the chiropractic profession.
For once let’s put to rest the destructive argument over diagnosis because it blurs the real issue. The issue is not whether we should diagnose (which by the way I feel is necessary for primary health care providers) but whether we should provide a scientific approach to treatment in the form of accurate, provable subluxation reduction. I think we all agree that the medical physician does a pretty fair job of diagnosis. Chiropractic colleges are preparing their graduates in this area but certainly no better than their medical counterparts. Our practitioners must be prepared not only in diagnosis but also in the accurate location and effective reduction of the vertebral misalignment factor. This means the modern day chiropractor must understand basic mechanics and physics. He must determine from accurate measurement the necessary information to reduce the misalignment factor. He must accurately x-ray the patient not only to determine the presence of pathology but to remove the guesswork that is inimical to inadequate palpation procedures.
The emphasis in any chiropractic doctor’s office should be directed toward the basic goal of subluxation reduction. If this is done properly there should be no reason for those who do not use adjunctive procedures to try to deny that privilege to others. However if the rehabilitative procedures become primary in the chiropractor’s office at the expense of inadequate subluxation reduction there is a major cause for concern. For a patient to enter a chiropractic office and receive every treatment but a spinal adjustment is tantamount to entering a dentist’s office and never getting your teeth checked. Yet this is happening in some of our offices today.
The reason this situation exists lies not only with the colleges and with the lack of adequate research, but with apathetic field practitioners who seem satisfied as long as their wallets are full.
Is it any wonder that the scientific community has trouble accepting our theories when our own practitioners put up roadblocks to prove the scope of the subluxation complex? An example of this is a statement made recently by a prominent chiropractic radiologist at a seminar where this writer was in attendance. The statement was made that “post x-rays are criminal.” That concept flies in the face of bonafide credible research by NUCCRA. How can this radiologist defend an approach which introduces guesswork in the place of relevant mechanical principles? Interestingly, this prominent chiropractic x-ray specialist advocated several theories regarding some crude forms of film measurement that are accepted by the medical community. It appears that measurement is only valid when done by a medical physician. This is the same approach advocated by the so-called insurance consultant when he rejects chiropractic criteria but unabashedly embraces anything medical. If we don’t insist on the development and use of our own criteria we will be a profession without a foundation.
The October 1982 issue of the NUCCA Monograph contained an article by Ralph R. Gregory, D.C. regarding the mechanics of the C-1 adjustment. It dealt with the application of physical energy or force to correct an atlas subluxation. Dr. Gregory wrote: “To move a vertebra from one misaligned position to another misaligned position does not constitute a vertebral adjustment.” The direction of force in a spinal adjustment is critical to misalignment reduction particularly in the cervical spine. Without accurate comparative post x-rays the practitioner has no frame of reference with which to accurately judge the effectiveness of the adjustment. Post x-rays films taken after the first adjustment will tell the degree of vertebral reduction and verify the correctness of the analysis.
They will tell the doctor whether any changes are necessary for complete correction. Otherwise he has only symptoms upon which to base his conclusions. This certainly is not a method acceptable to the scientific community.
l used the statement of the radiologist to give only one example of a serious lack of understanding of priorities within chiropractic. Just reading our journals one can see that very little emphasis has been given to improving the mechanics of subluxation reduction or to methods to improve misalignment identification. NUCCRA represents a small but effective nucleus around which to build the proof of our concepts and provide a solid basis for the chiropractic profession. Had the radiologist known of a NUCCRA study concerning the analysis of x-rays, his position might have been different. The thrust of the research was to prove that x-rays can be marked with precision using rotarory measurement and an x-ray that is properly aligned. The results indicated that five different NUCCA doctors read the same ten sets of x-rays with a reliability coefficient of .93 for the rotation vector and .96 for the height vector.
This type of research is only a beginning but it is a valid beginning. Any thinking chiropractor knows that the application to today’s physical sciences is the only road to the proof of our concept.
We need not travel the road of the osteopaths. The so called prestige of immediate acceptance is not worth the price. Only you can answer this question: Will there be a chiropractic tomorrow or will we be merely a transparent copy of the allopathic physician with no real foundation upon which to base our claim of individuality?
Science, discipline, dedication and integrity – words that have been synonymous with the title of doctor. Another word must be added to that list – responsibility. Responsibility to our patients, to the scientific community, to our profession and, last but not least; responsibility to ourselves and our own identity.