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Let's Get Small

Chiropractic patient education makes chiropractic big!Who awakens in the morning and proclaims, "Today, I want to be less significant. I want to be less important. I want to play a smaller role on the stage of life!"

No. For most of us, the reverse is true. We want a larger business. We want to play a more significant role in the lives of others. We desire greater impact, more influence and to contribute in more meaningful ways to those we touch.

Then why are some chiropractors so bent on minimizing chiropractic? Why are so many willing to reduce chiropractic to a localized therapy to improve spinal biomechanics? Why do so many decry the value of chiropractic for whole body health? Or its value for children? Or its use by those who are asymptomatic?

Why do they desire to make chiropractic small?

Perhaps they are the cautious type, preferring that chiropractors toe the line, under-promising the possibilities of chiropractic. They appear to be waiting for sufficient randomized controlled clinical trials published in peer review journals before suggesting chiropractic could help anything beyond headaches and back pain. Rallying behind the self-imposed condemnation of "evidence-based medicine," they are embarrassed by their chiropractic colleagues who regularly report success with colic, ear infections, asthma and dozens of other health problems manifesting from correctable subluxations.

Oops! Sorry.

The "let's-get-small" crowd finds the word subluxation problematical. Perhaps because the definition attributed it by traditional medicine differs from the one generally used in chiropractic. (Or is it that insurance companies don't reimburse for its reduction?) But, every discipline has its own lexicon. The word "enamel" means something different whether you're a painter or a dentist. The word "bridge" has different meanings whether you're a dentist, engineer or a musician. Need I go on?

But perhaps it's the "approval" or acceptance by medicine that's really at work here. Ironic, because downplaying what reducing nervous system tension could do, is lost on a profession that has become lap dogs to pharmaceutical interests and turned disease mongering into a fine art.

Perhaps what fuels those aspiring to second-class citizenship are those situations in which chiropractic doesn't appear to work. Every chiropractor has had cases in which appropriately applying chiropractic principles don't seem to produce the expected outcome. The question is, will you fall for the trap of seeing that "failure" through the linear, cause-and-effect, recipe-book lens of the medical mindset? Those who do, have probably fallen for one or more of these popular deceptions as well:

Chiropractic treats disease. You can treat your redwood deck to repel water. You can treat your child to an ice cream cone. And you can treat water so it's drinkable. But chiropractic doesn't treat anything.

Treating suggests lack; that something is missing and must be added to create wholeness. For example. Those with headaches aren't suffering from a lack of aspirin. Yet, those who take a pain reliever for the purpose of reducing pain are in fact, treating their headache.

Chiropractic doesn't treat headaches or anything else. And this isn't merely semantics! Reducing nervous system tension, usually along the spine, can often relieve headaches and countless other unwanted symptoms. But that would be a possible effect, not the cause. If you believe your chiropractic care is a treatment for headaches you are practicing medicine. For which you are not licensed.

"But patients come in thinking I can help them with their headaches!"

Sure. That's what most people, weaned on a medical approach to symptom-treating their entire life would naturally believe. So you have a couple of choices:

1. You can commit to educating patients about the truth.
2. You can ignore their preexisting beliefs and take credit for the results chiropractic so often produces. But then you must also take blame for the occasional failures.

Clearly, if you want to show up with integrity you have some significant communication obligations!

Chiropractic is about the spine. Chiropractic is no more about the spine than buying a car is about the color you choose.

Chiropractic is about the integrity of the nervous system. The spine is involved only because physical, chemical and emotional stress that exceed the nervous system's ability to accommodate is often exhibited by malfunctioning spinal joints. Which are merely symptoms, since bones are static structures that only move when commanded by muscles. And those muscles only contract when commanded by the nervous system. Chiropractic is a neurological discipline, not an osteological profession.

There's a contingent within chiropractic that believes getting the bones to line up properly will permit the nervous system to function as designed. At first glance, this makes sense and appeals to the most analytical segment of the profession—until he or she is confronted by a gorgeous cervical curve—yet the patient's headaches remain unresolved.

Like the electrician focused on the circuit, not necessarily the color of the wire's covering, effective chiropractors recognize it's all about the brain's ability to faithfully control and regulate the body. Everything else is an effect.

Pain is the problem. While patients often seek chiropractic care because of an ache or a pain, pain is not the problem. It's a symptom. An effect. A signal. A sign. An indicator. A warning. Pain can be distracting, debilitating, irritating or annoying. Pain can be chronic, acute, intense or intermittent. Pain can be sharp or dull. And pain can be localized or general. But pain is not the problem.

It's bad enough when patients are misled into thinking their most obvious symptom is the problem. What makes it worse are the empathetic chiropractors who think the patient's problem is their problem; that the patient's headache is their headache. These are the chiropractors who then fall into the trap of "treating" the patients symptoms—again the practice of medicine for which they are not licensed.

For most patients, being pain-free is their only objective. Which is why many chiropractors may indulge this exploration as merely an intellectual exercise. Yet, these are the same chiropractors who complain of a lack of new patients, whine about abuse at the hands of insurance carriers and never really enjoy a stable, emotionally-fulfilling practice. They disconnect from the philosophical implications of what they do and overlook their patient communication responsibilities and then can't figure out why the world conspires to make their path so difficult.

Adjustments "fix" patients. With the treatment mentality so sloppily taught at most chiropractic colleges, chiropractors often emerge with belief that their thrusting is actually repositioning spinal structures! If the "bone is out," so they reason, "thrusting here and here will put it back where it belongs."

This is fraught with so much ego and hubris I don't know where to begin!

But here goes. Again, bones are static structures that only move when commanded by muscles. Muscles only contract when commanded by the nervous system. And the nervous system employs this defense strategy when it is overwhelmed by physical, chemical and emotional stress. Tragically, many chiropractors see the effect (bone out of place) and start visualizing what direction their thrust needs to be applied to put things back in their proper place. They forget to ask two important questions:

1. What were the likely physical, chemical or emotional overwhelms that produced the survival strategy showing up as a subluxation?

2. Is that physical, chemical or emotional stressor(s) still present in the patient's life? (Otherwise, adjusting the patient will be ineffectual!)

Instead, the adjustment adds energy to the body at opportune places and the body decides how (or if) it will use the energy to "right itself." This starts to explain situations in which chiropractic doesn't appear to "work." You can do everything correctly but neglect to...

...find out that the patient is drinking a six-pack every night.
...discover whether their boss is still threatening to fire them.
...uncover that they suspect their oldest son is on drugs.
...learn that the patient only gets four hours of sleep a night.
...ask about the ergonomics of the workstation they sit at all day.

Messy? Sure. But it's essential if you have any hope of emerging from being a mere spine mechanic. Considering the spine, isolated from the patient's life is convenient, but sets you (and the patient) up for disappointment.

Technique matters. The profession is just about mature enough to accept the fact that virtually all the named techniques, when masterfully delivered, can produce a positive result. Oh sure, there are still some who believe that tonal and emotional techniques aren't really chiropractic. And then there are the misunderstood "experimental" techniques that sully the reputation of chiropractic. But that's mostly ignorance.

Chiropractic history is replete with examples of those who thought the X approach was superior until the developer of the Y approach came along. Who was supplanted by the new and improved Z approach to spinal adjusting.

Turns out that how you adjust is less important than why you adjust.

Results are predictable. Those who would prefer a cookbook approach to chiropractic care would probably tire of it after a month or so. Thankfully, every human is a dynamic, constantly changing organism. To think of patients as identical canvases on which Intervention A should always produce Result B might be comforting, but flies in the face of reality. This is why the gold standard used in researching drug efficacy is misapplied when used to measure chiropractic outcomes. We're each an experiment of one!

Every person has a varying capacity to adapt to physical, chemical and emotional stress. For one person snakes are docile pets. For others an evil reptile. Same snake, different response. Same with chiropractic. This is the danger of making chiropractic about chiropractic, rather than making it about the patient.

Chiropractic should be uniform. With the metaphysical all but excised from the curricula of most chiropractic colleges, there will come a time when the practice of chiropractic will likely be more uniform. Whether it can be accurately called chiropractic remains to be seen.

The medicalization of chiropractic is happening at the same time that the Bernie Segals, Deepak Chopras, Wayne Dyers and Andrew Weils are enjoying incredible attention as they talk about intention, innate healing, energy and other subjects that have practically become recessive genes in the chiropractic DNA.

Those who chose chiropractic as a shortcut to becoming a "doctor" or who saw it as a way to make a lot of money can be forgiven. But chiropractic has always been about the feral, the renegade, the rebel and the outcast. Chiropractic is different. This difference has produced results when other methods have failed.

Those who believe chiropractic is merely a low-tech strategy relegated to the correction of back and neck problems have bought the first right answer. Sure, chiropractic is good at helping these types of problems. And yes, if medics would drug and cut less on these types of cases, chiropractic could help such patients faster, less expensively and with fewer unwanted effects. But that is hardly the highest calling to which chiropractic can aspire!

Minimizing chiropractic may be a pragmatic way to convince those who hold the purse strings to invite chiropractors to the health care dance. But it downplays the significance and potential of chiropractic. Could it be that this is what stirs the "principled," "philosophical" and "zealous B.J. wing" of the chiropractic profession? To those who became chiropractors because of a personal experience that transcended the narrow orthopedic model, making chiropractic small is seen as a sell out. It's seen as self-deprecation; a bait and switch strategy that will entrap chiropractors, reducing them to neck and back therapists.

Does that mean I condone chiropractors who run advertisements promising a cure for acne? Or a treatment for any other named disease? Of course not. Chiropractic is neither a cure nor a treatment.

"WELL THEN, WHAT IS IT?!?"

Great question. If you're not sure what chiropractic is, you might be inclined to believe those who say it's small. But of all the things chiropractic is, it's not small. It can be practiced small, but it's a big idea. Huge, actually. Get the huge idea and all else follows.

Comments (5)

Nick Hansen:

Aside from working in my office, I work at a medical group dealing with personal injury. These people usually are being exposed to chiropractic for the first time, I'm being rushed (after all the MDs feel I'm just a technician) and a lot of times I'm just flustered. Bottom line - What's a good one liner or so to explain chiropractic that's dramatic enought to catch the attention of a patient who is in too much pain to think about it and may be so filled up with allopathic crap that they will (likely) not see me as a "real doctor" after all the staff routinely asks, "Do you want to see the doctor or the chiropractor?"

I'm working this second job to get the banks off my back. I know I may be "impure" but I'm exposing people who would have never considered chiropractic. And I do try and "talk the talk" as much as I can.

WDE: Gosh, I hope the circumstances in which you're delivering your care don't serve to work against you! My guess is that rather than something pithy to say to patients, you might turn your attention to educating the MDs you're working with.

Do You Have Pain?
Come see me to find out how I don't treat it!

I wonder why the public feels chiropractors treat pain? Maybe it is because that is all the profession advertises? Why? Because fewer people will come through the door for a system of optimizing the nervous system for an increased level of health? Studies show that this is true! Why? Because the public has been brainwashed as to how to take care of their health. How do I change the public perception of health by myself, because the profession sure has not made much of an effort? One patient at a time--or more if I can book lectures in the community.

Most chiropractors are just trying to keep their head above water and are not living with passion for what they do and in turn do not inspire passion in their patients. Even the busiest chiropractors that I know, are not making a dent in the public perception of health. Yes, they have influenced the people they come in contact with, but at large, most people do not know what chiropractic is and what we do.

Based on this post, most chiropractors don't know, or don't care. The really sad thing is, that if I somehow got an hour on Oprah to talk about health and chiropractic, there would be a lot of chiropractors who would scream about the message that was delivered, that it did not represent the profession, I dare say I would be called a quack and although I don't care about names, this would once again confuse the public and serve no one.

Where is the excitement and passion of BJ and DD now? Do they exist? They were broadcasting on the biggest media platforms of the day, yelling from the tops of the mountains about what they knew. Where is chiropractic now on these media platforms-- it's not there-- why is it not there? Because the people with the ability and the money to accomplish this don't care about changing the public perception about health or can't agree as to what chiropractic is or does. So here I sit changing lives one at a time like many of the chiropractors through history, thinking that maybe, someday, someone, will change the world.

Tony Russo:

Revealing and impactful, is all I can say although I'm flip-flopping with this one. It certainly doesn't give anyone the warm and fuzzies, that's for sure. But you hit the point right on the bull's eye as to why people become Chiropractors. Man do they find out, the hard way, that this is by no means any easy way to, "be a Doctor or make lots of money." Yet what you are suggesting may be somewhat out of our scope of practice if we decide to address the real cause of people's problems.

Very revealing though. Now, you remember I suggested in one of your previous issues that this be given to every graduating Doctor of Chiropractic? Well this issue should be distributed to every potential candidate for Chiropractic College. Or should it? For it would only serve to plummet enrollment in Chiropractic Colleges.

I would like to suggest reading Bill's article "Where did all the Chiropractor's Go?" I think that his well articulated comments are parallel with the thoughts in the current post. I'm refreshed with the thought of how big chiropractic really is. Chiropractic is not a procedure, but a lifestyle that gets me juiced every single day! I will continue to affect my corner of the world, by helping to brand what chiropractic truly is... BIG!

Mark Croucher:

The art of chiropractic routinely gets lumped into certain categories depending on the source. This is just as much our fault is the fault of others. I am by no means perfect on that note. I certainly do not have the final word on what chiropractic should or should not be. I primarily take care of people with chronic pain related to the spine. I'm good at it and the management makes sense to me. At the same time I communicate to patients that chiropractic care can have far reaching influence on a person's health. The action of the chiropractic adjustment has effects on the nervous system that go well beyond our understanding. Many of these effects have been illuminated but I think they are mostly unknown at this point. In my own practice my efforts are to communicate where I think my strengths are and how a person may react to my care from a symptomatic and wholistic point of view. I try to steer clear of dogma and fundamentalist points of view. If I maintain this perspective of service to the patient...my practice flourishes, my psyche stays healthy and my public image stays consistent.

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From January 12, 2008 11:15 AM

This page contains a single entry from the blog posted on January 12, 2008 11:15 AM.

The previous post in this blog was Do You Hog the Ball?.

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