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Adjustment

Posted on 30. Mar, 2013 by in Learn

Spinal manipulation:

Why is the chiropractic adjustment different?

A brief answer. My opinion…

By Joseph J. Ierano B.Sc., D.C. Doctor of Chiropractic

Did chiropractors discover spinal manipulation?

No they did not. Manipulation of the spine has been performed for an estimated 4000 years. The ancient civilisations did not just use chemicals for the treatment of illness, nor did they ignore physical methods for the cure of infirmity.

Hippocrates, known as the father of modern medicine, used spinal manipulation and allegedly wrote about looking to the spine as the cause of disease. It appears that modern medicine is in denial of recognising their own brilliant Greek as the possible father of spinal manipulation. Also of importance is his recognition of health coming from an innate source within us all: vis medicatrix naturae they called it. This is the basis of wholistic healing today. The modern chiropractor relies heavily on a scientific research and clinical experience to explain the effects of chiropractic, without relying on conceptual philosophies of old.

Chiropractic’s founder DD Palmer in 1895 advocated that he had not discovered the art of spinal manipulation, but rather its specific adjustment using spinous and transverse processes as levers. He also spoke of innate intelligence being normalised when the spine is functioning correctly. In short, the chiropractic form of manipulation is so specific in force, direction, location and purpose, that we refer to it as an “adjustment”. Today we know that a complex array of neurophysiological effects cascade from chiropractic interventions that take it beyond belief, into fact and data.

Who performs manipulation?

In Australia, there were 4 professions registered to manipulate the human spine:

  1. Chiropractors
  2. Osteopaths
  3. Physiotherapists
  4. Medical physicians

Chiropractors represent the majority of this group who manipulate the spine. They have been registered since 1978 in Australia, as early as 1964 in WA, thus ensuring safety and educational superiority in methods used to adjust the spine, through government regulation. Before this date, virtually anyone could do it, and could call themselves a chiropractor…even a charlatan. Now, since national registration in Australia, the only protected practice is cervical manipulation. The rest is a legal ‘protection of title’ rather than practice.

What are the differences?

All professions have crossover points, so the distinguishing features will be highlighted here. I attempt to point to any benefits associated.

Medical physicians

Very few medical physicians manipulate the spine. The component of education dealing with neuromusculoskeletal (NMS) anatomy, diagnosis and treatment in the medical doctors degree is less, when compared with the chiropractor. Many of the few MDs who do manipulate the spine have probably attended further study. Most go on to be specialists. Benefits include medicare rebate and licence to administer drugs. Better access to emergency and specialist care protocols denied others. GPs can not perform radiography/radiology but rely on specialists.

Physiotherapists.

Some physiotherapists are skilled at manipulation of the spine for treatment of certain conditions. Though not as comprehensive as the basic chiropractic program in teaching manipulation, some physiotherapists do extensive further education in this field and are quite competent. As a profession, though, those that do spinal manipulation are a minority. Advantages include an ever expanding educational curriculum, and arguably, a better relationship to the public medical health system, with around ten times the referral rate from MDs. Do not take x rays. Excel in other non-manipulative areas. Have good hospital access, and the degree of study is ever increasingly tough, since their inception initially largely from the massage therapy profession.

Osteopaths

Osteopaths have a history of spinal manipulation that is a little longer than that of chiropractic. Around 1875. It has always been considered a separate profession (though lumped in with chiropractors registration in Australia until 2002) and has a similar philosophy of releasing the inborn ability of the body to heal itself, albeit through improving circulation, where chiropractors claimed through nervous system. An almost unwinnable argument! Sadly, in the USA osteopaths have been all but absorbed by the medical profession, now licensed to do surgery and dispense drugs. It is estimated that only 5% use manipulation. Here in Australia new schools are emerging that remain fairly traditional in encompassing a wide variety of tools such as nutrition, muscle therapy, exercise and manipulation. Advantages include a diverse range of approaches, similarly as with chiropractic, they are excellent diagnosticians and help lots of conditions. Denied hospital recognition. Pre- 1990s, Colleges existed in Australia which granted a diploma in both osteopathy and chiropractic concurrently. This probably added to the confusion.

Chiropractors

Chiropractic has had at the core of its practice a type of manipulation that is so specific that they refer to it as SPINAL ADJUSTMENT. For instance, for decades the foremost school of chiropractic in the world focused on adjusting only one bone at the top of the neck, the atlas. Another school used physiologic therapeutics before there was even a physiotherapy profession; as early as 1912. Is this not remarkable? They now refer to their course as ‘chiropractic medicine’. The diversity is certainly evident.

This is not characteristic of all chiropractic but illustrates the differences, that is:

  1. Specificity, or adjusting only one or two joints at a time, as opposed to general manipulation of a whole area of the spine.
  2. Speed. The adjustment is quick and often not even sensed by the patient
  3. Low force. Excessive force probably involves other joints not intended to be affected
  4. Amplitude. The depth of the force is also controlled
  5. Some techniques use no manipulation at all, but an adjustment that affects the joint within its normal range of motion. Other professions move the joint forcefully just beyond the normal range of the joint. Chiropractors know when to employ either adjustment, manipulation, mobilisation or soft tissue therapy.
  6. Most importantly, there is a philosophy behind the practice that is largely ‘conservative’. Or without drugs or surgery. Chiropractors treat no organic disease directly, but remove spinal interference to healing, which has global effects.
  7. Are qualified skeletal radiographers and radiologists, unlike any of the above.

Disadvantages: Hospital privileges almost nil in Australia; history of outrageous claims in certain interest groups; early years of alleged benefits and theoretical constructs without proper scientific investigation, outside of mainstream academia for many years until the first university program in 1990. A world first in Sydney.

Who can benefit from spinal adjustment?

Today, or until recently, we tended to go with the flow of accepted mainstream drugs and surgery but now people are going non-invasive solution health providers in droves. There was a time when chiropractors could be disciplined for telling patients not to take antibiotics for a mild condition, to avoid bed rest, limit use of neck collars…now its medical fact! The researcher Eisenberg has reported extensively that in general in the USA more people are going to “complimentary / alternative medicine” (CAM) providers, paying out of their own pocket. Other studies looking at CAM have shown these people are better educated. These figures appear to stand equally in Australia as well.

The future

The future will hopefully see all of these professions remaining separate and distinct but working collaboratively together to help the patient. All will strive to improve effectiveness and safety of their procedures. In the free market place, it is hoped that the one(s) who does it the best (less time, cost, risk; greater benefits) will prevail.

One thing is clear – the consumer has the power to choose and no longer relies on a patriarchal model of health that was once based on “doctor’s orders”. This means that the historical “watchdogs” of health, such as the established medical journals and medical trade unions like the AMA, can no longer rely on telling people what to think, but to offer information. Which, currently, when it comes to spinal manipulation and chiropractic care, is misinformed and lacking.

Summary

Manipulation:

A manual thrust directed to move a joint slightly past the normal range of motion, without exceeding the anatomical limit, usually to treat a particular condition. Usually produces cracking sound.

Adjustment:

Any chiropractic procedure that uses a specific, controlled force with designated leverage, speed, direction, and depth at an individual joint complex only, with the strict intention of restoring function through removing improper neurologic input. May occur within normal range of motion, without a “crack”.

Other professions are now incorporating spinal manipulation. Chiropractic has had spinal adjustment procedures at the core of its practice the longest of all, since its beginning in 1895.