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The Art of Chiropractic

marco-polo.jpgLast week when I was in Spain, I became present to a subtle distinction that you might want to give some thought to. If my understanding is correct, it could significantly change what you do with every patient you adjust. Seems to me, becoming mindful of this observation could take the already excellent results you produce with most patients to an entirely new level. What could possibly be so revolutionary? A simple statement made by one of the speakers: “If you do the same thing, every time, with each patient there’s no art in your chiropractic.”

Profound.

We have conveniently divided the practice of chiropractic into its science, art and philosophy. The science and philosophy have often served as the battleground for the schism between the vitalists and the mechanists. However, the “art” of chiropractic seems to have been ignored, or at least relegated to the notion of “artfully” and masterfully delivering your particular adjusting technique. Yet, this too easily overlooks one of the most dangerous aspects of working with the nervous system: it learns.

While many chiropractors aim to retrain the spine to assume a healthier pattern, exhibiting better balance and symmetry; even restoring more normal curves, this gives their chiropractic intervention a bone focus. In the process, they may be overlooking the ever watchful nervous system that learns to depend upon the repeated (and often visit-to-visit identical) thrusts, rather than using the energy and pattern interruption to right itself. In other words, while the chiropractor’s intent may be to correct the biomechanical relationships, in the process, the nervous system comes to expect the outside-in energy. (This is the concept of “entrainment” which Network Spinal Analysis developer and genius Dr. Donald Epstein has so well addressed.) This raises an even more fundamental question about your clinical motives. Is your intent to “fix” their spine, or is your intent to facilitate the patient’s body to do the fixing? The former is dangerously egotistical; the latter requires surrendering to the humble role of a servant.

In other words, are you attempting to “wake up” the patient’s body, reminding it that the physical, emotional or chemical stressor that produced the defense mechanism we call subluxation is no longer present and a more appropriate state or “tone” can be assumed, or are you attempting to use the energy you administer to their spine as a way to overpower the body’s errant way, like some physical therapist’s maniacal work hardening routine?

Is this why so many chiropractors (and patients) have come to link the sound of cavitation with the notion that progress is being made? "Not there…" [thrust] [CRACK!] "…there!" The implication is that the patient’s body is stupid and needs you to put things right. No wonder so many with this mechanistic bent find tonal techniques so abhorrent and unsatisfying. “It’s not even chiropractic,” they mutter self-righteously.

Seems to me (please remember I don’t know how to adjust), that a healthier relationship with the patient’s spine and nervous system would be to artfully remind it that the threat is gone and that it can relax from its now, inappropriate fight or flight response. And if that’s true, it would seem important that what you do on each visit should be different from what you did on the last—a neurological game of Marco Polo. Wake up! Over here! It’s okay! Now this! Marco! Polo!

Naturally, this approach requires considerably more thought, a mindful presence and clear clinical intentions. (You thought being an artist was easy?) Take this on and you avoid one of the most common clinical snares among chiropractors: thinking your thrusts are fixing the patient. If there’s going to be any fixing (or healing), the patient’s body will do it. If your adjustments are going to “hold,” it will be up to the patient’s body to hold them. Mindlessly thrusting the same way on every visit is drug-like, dumbing down the power of an adjustment. It neglects the art of chiropractic.

Am I missing something here?

Comments (6)

Dr. Richard Cohen:

Bill,
Living in Barbados I get a chance to meet chiropractors trained in the US, Canada and Europe and am shocked that the majority are so poorly trained or not trained in the use of a variety of chiropractic techniques [i.e., osseous, soft tissue, cranial, muscle energy, neuro-emotional, etc]. They fit all patients into the same mold. They do not know had to match specific techniques to what the patient needs and innate wants. Network and clinical kinesiology are examples of techniques that match specific chiropractic methods to the patient’s needs. They are trained as limited neck and back technicians with little or no concept of chiropractic as a healing profession.

No wonder so many practices fail

In conclusion, all I can say is too many of our schools have failed their students and our great profession.

Bill,
It sounds like you are "sold" on tonal techniques. In my experience, chiropractic is not as much about the technique as the chiropractor utilizing it. Just because there is an audible with an osseous technique does not mean that the chiropractor is not addressing nerve or changing tone or removing the lasting adaptation response of the body to stress-- If the right chiropractor is using the right technique-- the body will respond. There has always been talk about that special something-- the unteachable portion of technique, this special something is about the doctor not the technique. Ultimately, even tonal techniques are a doctor doing something to someone else-- if it is said that the tonal doctor is doing nothing and the body is purely correcting itself then what purpose does the tonal doctor serve? Is he not triggering the change? Giving the body the signals it needs to change? How is this different from other techniques? Aren't the osseous technique doctors giving an external trigger to allow the body to correct itself? Of course you should check each and every visit to "see" if the adjustment that you are about to give is appropriate-- in the right place at the right time and your intent should be to affect the neurology of the patient-- if the doctor is just pounding meat with the intent of making a buck, there is a huge problem with that.

WDE: All techniques, when masterfully delivered, can have value. Ultimately, it’s about intent.

How well said.

I don't always read, I don't often comment on your blog, but I do love it. It is always to the point. Thanks !

Kimberly Higney, D.C.:

Well-said Bill. My nervous system is learning and adapting constantly...I certainly would expect my chiropractic care to observe, respond to, and facilitate continued adaptability. I would also expect to offer nothing less than this to practice members under my care.
Thank you again for providing clarity and new distinctions.

Pack Miracle, D.C.:

Yes, you are missing something! Check out Dr. Thurman Fleet and the Concept Therapy Institute for a simple and elegant explanation of how and why healing takes place. The art is in our hands, our heads and our hearts/souls.

Tony Russo:

Now that would take courage and humbleness. Something we all need to work on. Especially when patients walk in after years of not seeing you and singing your praise...only to be followed by patients who only saw you one visit and feel no better. So yes, for people who have graduated from their introduction to Bill Esteb, a wonderful and logical progression. For those just starting, you have a lot of "humbling" ahead of you.

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From May 7, 2008 7:50 AM

This page contains a single entry from the blog posted on May 7, 2008 7:50 AM.

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