What Is Chiropractic Anyway?
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November 16, 2006
WICA (18) Chiropractic Market
Why the pharmaceutical industry appears to be so successful, is because it understands its market. A sensory overload of physical, mental, or emotional stress results in a constellation of symptoms. These symptoms can be dermatological, cardiovascular, diabetic, thyroid, gastrointestinal, renal, rheumatic or even musculoskeletal. It's understood that one does not want to necessarily experience these signs for any given period, thus creating a need, and the need is met with a fast-acting, caffeine-enhanced nugget of solidified powder, which will either mask or alter the signs. The need is met adequately, I'd say, because pain is a perception. It's a culmination of things that are organic, psychological, psychosocial and environmental, accumulated and perceived in and by the brain. Nowhere else. There is also an emotional overlay to every experience: How you feel about how you feel. And more often than not, this is the long lasting cause of any painful experience which continues to repeat, and repeat , and repeat itself in your mind and body long after the event. For years sometimes. Nerves that fire together, wire together - like learning. Even traumatic stress of a physical nature is known to manifest in changes to limbic (emotion), memory and other relevant stress centres in the brain. So now something that was just a single incident at one point in time in your life, has become a repetitive miscreation within your psychosomatic makeup and continues to pulsate its energy throughout your being time and again. Barring mystical meridians that might convey pent-up energy to any part of your body, let's bear in mind that one's physical, emotional architecture extends out the brain, through the skull and half way down your back in the form of your spinal cord.
With all this in mind now, the chiropractic market seems obscurely backward to me. From a general public perspective, chiropractic and pain seem to go hand-in-hand nowadays, and this is most often why treatment is sought. Low back pain costs the US about US$40 billion, and NZ around NZ$1.5 billion per annum, and is the second most common reason to visit a general practitioner next to upper respiratory tract infections. People hear that chiropractors deal with backs somehow, so after bravely overcoming whatever fear or misconception they may own, they trundle along to experience pain relief chiropractic style. Yet if we understand the natural history of low back pain, 70-80% of people will undergo remission of pain within three months regardless of treatment sought. One of the UK's largest randomised trials of 1334 patients [1], in assessing the effectiveness of physical treatment for back pain, cites in the British Medical Journal that the difference in functional outcome between exercise alone, and spinal manipulation therapy, after three months is so small that it questions the cost of therapy. Furthermore, it seems there is little evidence to support the long term benefits of spinal manipulation therapy for chronic low back pain. So what the heck does that mean? One, the cause of back pain must be something other than segmental, and two:
With all this in mind now, the chiropractic market seems obscurely backward to me. From a general public perspective, chiropractic and pain seem to go hand-in-hand nowadays, and this is most often why treatment is sought. Low back pain costs the US about US$40 billion, and NZ around NZ$1.5 billion per annum, and is the second most common reason to visit a general practitioner next to upper respiratory tract infections. People hear that chiropractors deal with backs somehow, so after bravely overcoming whatever fear or misconception they may own, they trundle along to experience pain relief chiropractic style. Yet if we understand the natural history of low back pain, 70-80% of people will undergo remission of pain within three months regardless of treatment sought. One of the UK's largest randomised trials of 1334 patients [1], in assessing the effectiveness of physical treatment for back pain, cites in the British Medical Journal that the difference in functional outcome between exercise alone, and spinal manipulation therapy, after three months is so small that it questions the cost of therapy. Furthermore, it seems there is little evidence to support the long term benefits of spinal manipulation therapy for chronic low back pain. So what the heck does that mean? One, the cause of back pain must be something other than segmental, and two:
Chiropractic must do something else.
But chiropractic plays the numbers game and markets itself to the astronomical figure of back pain suffers. Probably by default because the profession doesn't advertise itself as anything other. Shh... wellness is our little secret... let's hope others pass it on. And let's also surreptitiously hope that we can convert a back pain suffer into a lifetime wellness patient while we're at it. Unlike the pharmaceutical industry, it doesn't sell the opportunity of improved life experience through different brain function - like it should - it offers back pain relief because this is all people understand. It offers relief for something that will ultimately take care of itself. What the?
Okay, let's return to the beginning: A sensory overload of physical, mental, or emotional stress resulting in a constellation of symptoms. Chronic pain is associated with stress [2], and it's a matter of fact that stress affects systems of the body both musculoskeletal and non-musculoskeletal. There are hundreds of cases on the internet outlining chiropractic case management of non-musculoskeletal problems such as those mentioned in the first paragraph. These are issues mediated by stress responses that are oftentimes below your level of awareness. And like pain, the stress is perceived by areas in the brain and brainstem, to which your body responds accordingly by pumping a myriad of hormones and chemicals into circulation in order to deal with it. Dealing with this stress for long periods of time takes its toll on the body. And in modern day living, we all do it; we all expose ourselves to severe stress for long periods of time. Protein stores are depleted and the immune system becomes depressed. You get sick. Regardless of the season.
Chiropractic has its role in somatopsychic healing - from body to mind. Chiropractic has the potential to improve life experience through different brain function by virtue of changing these perceptions of stress within the body. It means you don't have to be in pain to be adjusted. Back pain is a symptom, not a cause. Of course chiropractors have always embraced this idea philosophically, but neither is there evidence to support that spinal derangements can cause prolonged, aberrant neurological reflexes [3]. Sadly, only one in two hundred chiropractors contributes to scientific literature [4] to give credence to their peers' work and help re-establish their position within the marketplace of healing and well being. Chiropractic needs these individuals to re-brand the profession as multifaceted biopsychosocial healing art; to provide a deeper understanding of function and to project philosophical ideas to new heights. The world is ready for what chiropractic has to offer, but if it's only the same one in two hundred that keep up with the literature, then I'm afraid it's the chiropractors that aren't ready, and the profession will drown in the deluge of misinformation that's fed to the public and be expunged because of it.
Okay, let's return to the beginning: A sensory overload of physical, mental, or emotional stress resulting in a constellation of symptoms. Chronic pain is associated with stress [2], and it's a matter of fact that stress affects systems of the body both musculoskeletal and non-musculoskeletal. There are hundreds of cases on the internet outlining chiropractic case management of non-musculoskeletal problems such as those mentioned in the first paragraph. These are issues mediated by stress responses that are oftentimes below your level of awareness. And like pain, the stress is perceived by areas in the brain and brainstem, to which your body responds accordingly by pumping a myriad of hormones and chemicals into circulation in order to deal with it. Dealing with this stress for long periods of time takes its toll on the body. And in modern day living, we all do it; we all expose ourselves to severe stress for long periods of time. Protein stores are depleted and the immune system becomes depressed. You get sick. Regardless of the season.
Chiropractic has its role in somatopsychic healing - from body to mind. Chiropractic has the potential to improve life experience through different brain function by virtue of changing these perceptions of stress within the body. It means you don't have to be in pain to be adjusted. Back pain is a symptom, not a cause. Of course chiropractors have always embraced this idea philosophically, but neither is there evidence to support that spinal derangements can cause prolonged, aberrant neurological reflexes [3]. Sadly, only one in two hundred chiropractors contributes to scientific literature [4] to give credence to their peers' work and help re-establish their position within the marketplace of healing and well being. Chiropractic needs these individuals to re-brand the profession as multifaceted biopsychosocial healing art; to provide a deeper understanding of function and to project philosophical ideas to new heights. The world is ready for what chiropractic has to offer, but if it's only the same one in two hundred that keep up with the literature, then I'm afraid it's the chiropractors that aren't ready, and the profession will drown in the deluge of misinformation that's fed to the public and be expunged because of it.
© Neil Bossenger 2006
New Zealand
Notes and references
- United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ, doi: 10.1136/bmj.38282.669225AE, 19 Nov 2004.
- Melzack, R., Pain and stress: A new perspective. 1999, New York: Guilford Press. 89-106.
- Hardy, K. and H. Pollard, The organisation of the stress response, and its relevance to chiropractors: a commentary. Chiropractic & Osteopathy doi: 10.1186/1746-1340-14-25, 2006. 14(25).
- Leach, R.A., The chiropractic theories: A textbook of scientific research. 4th ed. 2004, USA: Lippincott Williams & Wilkins.
- I'm off to Sunshine Coast, Australia, for five days. A much welcomed break. Happy holidays everyone.
- Past issues are now available at: http://understandingfunction
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