Articles by JCS

Chiropractic Paradigm

By Hands Only

The Chiropractic Paradigm

By

JCS

Now that you’ve learned the image of chiropractors has been a function of the AMA’s goon squad, media misrepresentation and avoidance, and the result of a few radical chiropractors within our ranks, let me give you the chiropractic model of spinal health. Indeed, if you were to ask anyone what chiropractors do, the most typical response would be simply, “They crack bones.”

Well, there’s more to our science than popping joints, but that’s a good place to begin with a quick anatomical lesson about the spine. Indeed, why do chiropractors adjust the spine rather than focus on discs; for that matter, why do most DCs not talk about health or disease as a function of germs or genetics—what is the madness to our methods?

The Forgotten Joints

Most people think of chiropractors as non-drug, non-surgical back doctors who treat problems like whiplash, low back pain, headaches, neck pain and sciatica. But what they don’t understand is why we adjust the spine instead of prescribing drugs, injecting shots or doing surgery—the standard medical methods.

  People who have never taken an anatomy class fail to realize that the human spine is comprised of 24 vertebrae sitting atop 3 pelvic bones—the sacrum and two hip bones (ilium). Even for those who have taken college A&P, even the most astute students and most physicians don’t know the number of joints in the spine. This is essential to the paradigm shift from the medical model of “pulled muscles” and “slipped discs” that has proven to be so terribly ineffective.

The fact is there are 137 joints in the spine from the top (occiput or skull) to the bottom of the pelvis. Imagine interconnecting the 24 vertebrae with 137 movable, gliding type joints (as opposed to ball and socket weight-bearing joints). In fact, you don’t slip discs as much as you first slip spinal joints.

The most logical question anyone should ask who’s been given the “slipped disc” diagnosis for the back pain is: What caused the disc to slip? That’s when most family doctors start to gag, unable to explain this faulty diagnosis that even their own researchers cannot substantiate the use of MRI scans.

Basic anatomy suggests that the slipped disc theory is implausible. A disc isn’t muscle that moves; but it is cartilage that acts as a shock absorber between the vertebrae. It may swell, bulge, protrude, tear or herniate at first when the spinal lesion or misalignment occurs. At first the inflammation is bad and, if uncorrected, the increase load on the disc will later cause it to degenerate, but a disc simply cannot “slip” as people are told. Certainly, if your family MD has told you your back pain is from a “slipped disc” and need shots or surgery, I suggest you run from his office as fast as your bad back allows.

Nothing happens to the shock absorbing disc cartilage until the mechanics of the spine cause problems, then like any sprained joint, the disc swells upon the nerve root to cause leg pain. Also, small nerve endings in the joint capsule are the source of axial back pain that also cause reflex spasms in the nearby muscles to brace the weakened area. As long as the spinal joints are jammed, these proprioceptive nerves will continue firing to cause pain and spasm.

In this light, the disc reaction is totally secondary to the mechanics of the spine, so if you don’t restore alignment and flexibility of the spinal joints, the disc will not return to normal size. To focus solely upon disc pathologies or abnormalities is to ignore to see only one tree and ignore the forest.

Recent research has shown that joint dysfunction and not merely a herniated disc may cause leg pain, another concept ignored by surgeons. Not only can joint dysfunctions cause back (axial) pain and disc abnormalities, now research has shown that joint dysfunction may also cause radiculopathy like sciatica, a condition long equated mainly to disc herniation, according to a study by H. Tachihara et al. in Spine.

“When inflammation was induced in a facet joint, inflammatory reactions spread to nerve roots, and leg symptoms were induced by chemical factors. These results support the possibility that facet joint inflammation induces radiculopathy.”[1]

This explains why many patients with back and leg pain get better with spinal adjustments alone. Rarely will most MDs will admit this treatment despite the obvious evidence that spinal manipulation helps many patients with leg pain; also, the same MDs be among the first to deny that slipped joints are the precursors to slipped discs. The medical model just will not admit the obvious despite the research and overwhelming evidence to the contrary.

Chiropractors aim to restore normal joint alignment and motion, similar to setting any joint that’s been slightly dislocated; in chiropractic parlance, what we call a vertebral subluxation, which is a vague term by any means considering that there are 296 terms that are descriptors or synonyms for "subluxation."[2]

Considering spinal joints can misalign in various fashion—twisted as sleeping incorrectly on your stomach, compressed as in prolonged sitting or a fall on your backside, wrenched as in a whiplash hyperextension/hyperflexion, or yanked as in a football tackle, there are innumerable types of spinal joint dysfunction that may involved to various degrees joint capsule sprain, ligament/tendon tears, and muscle strains. And most people have had numerous spinal injuries from the moment born with a forceps delivery to childhood falls on the playground, bikes, skates, to more damaging injuries sustained playing football, soccer and even cheerleading. Combined with the inevitable car accident or fall at home, most people have many spinal injuries of various age, degeneration, and severity.

Indeed, there are many co-factors to each spinal injury that it is difficult to diagnose them all with just one word. Just as the Eskimos have multiple terms to define “snow,” chiropractors, MDs, and PTs all have similar but dissimilar terms to define back problems. But one thing is for certain: the simplistic medical mis-diagnosis of “muscular sprain/strain” or a “slipped disc” are outdated and the common treatments of pills, shots, and surgery are ineffective.

Not Just Pain Relief

Not only does spinal dysfunction lead to back pain and often radiating pain into arms and legs, but researchers now tell us this chronic back pain also leads to a cascade of events—nerve degeneration, muscle weakness, organ dysfunction as we commonly see with Cauda Equina Syndrome that causes bowel and bladder incontinence.

Now research has shown that long standing pain also causes brain problems. In an article printed in The Journal of Neuroscience, researchers from Northwestern University found can shrink the brain by as much as 11%, equivalent to the amount of gray matter lost in 10 to 20 years.[3]

“Using magnetic resonance imaging brain scan data and automated analysis techniques, chronic back pain patients were divided into neuropathic, exhibiting pain because of sciatic nerve damage, and non-neuropathic groups.

“Patients with chronic back pain showed 5-11% less neocortical gray matter volume than control subjects. The magnitude of this decrease is equivalent to the gray matter volume lost in 10-20 years of normal aging. The decreased volume was related to pain duration, indicating a 1.3 cm3 loss of gray matter for every year of chronic pain…Our results imply that CBP is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processes.

Considering many patients with CLBP are also taking strong pain pills and narcotics, this only adds to the problem of brain degeneration, impairment, addiction and even death.

“The number of deaths...that involved prescription opioid analgesics increased from 2,900 in 1999 to at least 7,500 in 2004, an increase of 160% in just 5 years,” said CDC researcher Leonard Paulozzi, MD, MPH, in recent testimony to the U.S. Senate. “By 2004, opioid painkiller deaths numbered more than the total of deaths involving heroin and cocaine in this category.”[4] And those data, “probably underestimate the present magnitude of the problem.”

The number of U.S. residents using opioids is daunting. According to one set of estimates, over nine million Americans employ opioids for medical purposes every month, and another five million U.S. residents abuse them. As researchers from the CDC recently observed in JAMA, since guidelines from three major pain societies recommending expanded use of opioids for chronic pain were published in 1997, per capita retail purchases of methadone, hydrocodone, and oxycodone have increased 13-fold, 4-fold, and 9-fold, respectively.

The popularity of opioids as a treatment for low back pain has reached unprecedented levels. Back pain is the most common indication for opioid prescription among musculoskeletal pain complaints. A recent study of ambulatory care for back pain in the United States estimated that about 28% of patients with chronic back pain received a prescription for opioids in 2003–2004.[5]

The growing popularity of this treatment clearly raises the ante in terms of public safety.

“The population exposure rates to this treatment are quite high, so even modest increases in risk can have large public health consequences,” Von Korff emphasizes.[6] “I would say that nailing down the risks and benefits of long-term opioid therapy is among the most important research problem that exists regarding primary care practice at this time.”

Not only can chronic back pain shrink the brain, other scientists now believe degenerative disorders of the central nerve system may be responsible for fibromyalgia, chronic fatigue, post-traumatic stress disorder, irritable bowel syndrome, and depression, as well as the similarity of many CNS abnormalities.

According to an article by P. Schweinhardt et al. in The Neuroscientist.[7]

“Despite the numerous cerebral alterations, fibromyalgia might not be a primary disorder of the brain but may be a consequence of early life stress or prolonged or severe stress, affecting brain modulatory circuitry of pain and emotions in genetically susceptible individuals.”

Perhaps this study affirms the belief that a cyclical pattern exists in the brain and nerve system: early childhood spinal injuries/spinal cord stress slowly causes cerebral degeneration that then manifests itself in neurologic disorders in adulthood. In this light, chiropractic spinal adjustments that reduce or eliminate back pain would thus reduce the damage to the brain and improve the brain modulatory circuitry of pain and dysfunction.

The same researchers noted:

“This article presents evidence that fibromyalgia patients have alterations in CNS anatomy, physiology, and chemistry that potentially contribute to the symptoms experienced by these patients... Furthermore, functional brain imaging studies revealing enhanced pain-related activations corroborate the patients' reports of increased pain. Neurotransmitter studies show that fibromyalgia patients have abnormalities in dopaminergic, opioidergic, and serotoninergic systems.”

There is great significance in abnormalities in dopaminergic, opioidergic, and serotoninergic systems, so let me define these terms.

·                     Dopaminergic means related to the neurotransmitter dopamine that has many functions in the brain, including important roles in behavior and cognition, motor activity, motivation and reward, sleep, mood, attention, and learning.

·                     Serotoninergic neurons located throughout the brainstem share the function in the regulation of systemic pH homeostasis. Most intriguing is the supposition that the dysfunction of these medullary and midbrain serotoninergic neurons might lead to migraine headaches, anxiety or panic disorder, or lack of arousal leading to suffocation, or in the case of infants, sudden infant death syndrome (SIDS).

·                     The opioidergic mechanisms have a psychophysical effect of elevating mood and reducing pain perception.

Neuro-scientists now believe chronic pain, much of which may stem from chronic low back pain as Dr. Apkarian revealed, causes more than just pain since it appears to cause cerebral degeneration/alterations, but they admit “a single mechanism is as of yet not known.” How ironic would it be if spinal dysfunction begun during youthful sports falls, accidents or sport injuries, were the mechanism of this malady—problems that simple chiropractic spinal care would alleviate?

“Chronic pain patients suffer from more than just pain; depression and anxiety, sleep disturbances, and decision-making abnormalities (Apkarian et al., 2004a) also significantly diminish their quality of life. Recent studies have demonstrated that chronic pain harms cortical areas unrelated to pain (Apkarian et al., 2004; Acerra and Moseley, 2005), but whether these structural impairments and behavioral deficits are connected by a single mechanism is as of yet unknown.”[8]

Not only can chronic back pain lead to brain degeneration and pre-mature aging, new links to other chronic ailments are now emerging. More researchers found similar degeneration of the brains in women with fibromyalgia, which has traditionally been classified as either a musculoskeletal disease or a psychological disorder. But accumulating evidence now suggests that fibromyalgia may be associated with CNS dysfunction.

In this study by Anil Kuchinad et al., MRI scans of the brains of 10 female fibromyalgia patients and 10 healthy controls found that fibromyalgia patients had significantly less total gray matter volume and showed a 3.3 times greater age-associated decrease in gray matter than healthy controls.[9]

         The longer the individuals had had fibromyalgia, the greater the gray matter loss, with each year of fibromyalgia being equivalent to 9.5 times the loss in normal aging. In addition, fibromyalgia patients demonstrated significantly less gray matter density than healthy controls in several brain regions...The neuro-anatomical changes that we see in fibromyalgia patients contribute additional evidence of CNS involvement in fibromyalgia.

“In particular, fibromyalgia appears to be associated with an acceleration of age-related changes in the very substance of the brain. Moreover, the regions in which we demonstrate objective changes may be functionally linked to core features of the disorder including affective disturbances and chronic widespread pain.”

Objectives: To solve the problem of Sympathetic Nervous System (SNS) – Parasympathetic Nervous System (PSNS) quantification in order to analyze general Autonomic Nervous System (ANS) status and help to determine risk of sudden cardiac death.[10] 

In this prospective study, we set out to determine whether analysis of heart rate variability (HRV) in patients with exercise-induced ventricular tachycardia (EIVT) and normal coronary arteries would reveal increased sympathetic nervous system activity. Our results suggest the presence of increased sympathetic and decreased parasympathetic tone in patients with EIVT. We conclude that EIVT is associated with an imbalance in the autonomic nervous system between sympathetic and parasympathetic activities.[11]

Conclusions The results indicate that autonomic imbalance as reflected in an abnormal pattern of heart rate variability evolves early in the course of ventricular systolic dysfunction consisting of both a significant increase in sympathetically influenced low-frequency heart rate variability and a significant reduction of parasympathetically mediated high-frequency variability. The early appearance of these autonomic abnormalities suggests that autonomic imbalance plays a significant role in promoting the progression of circulatory failure.[12]

Chiropractic Care Recommended for Fibromyalgia

This research has been acknowledged by some important guidelines that rely on evidence-based criteria and now recommend chiropractic care for the treatment of fibromyalgia.[13] The American College of Occupational and Environmental Medicine (ACOEM) recommends chiropractic care in its Occupational Medicine Practice Guidelines treatments for several chronic pain conditions including complex regional pain syndrome (CRPS), neuropathic pain, trigger points/myofascial pain, chronic persistent pain, fibromyalgia and chronic low back pain. The recommendations are based on more than 1,500 references, including 546 randomized, controlled trials.[14]

ACOEM's latest chronic pain guidelines represent a step in the right direction in terms of recognizing the value of chiropractic care. The guidelines actually recommend manipulation for chronic, persistent low back or neck pain and cervicogenic headache.

The American Academy of Family Physicians published “Treating Fibromyalgia” and admitted this elusive disorder is not psychosomatic, but is directly associated with “musculoskeletal pain unrelated to a clearly defined anatomic lesion” and that chiropractic treatment has proven effective.

 “Fibromyalgia can be perplexing to patients and physicians because of the lack of associated abnormalities on readily available diagnostic tests. Despite this, recent findings about the pathogenesis and pathophysiology of fibromyalgia have dispelled the belief that the disorder is psychosomatic. While no laboratory test can confirm fibromyalgia, most patients present with a history of widespread pain, physical findings and co-morbid conditions. With experience, the disorder may be diagnosed with confidence on initial presentation or after a period of observation and minimal diagnostic testing…A diagnosis of fibromyalgia should be considered in any patient with musculoskeletal pain that is unrelated to a clearly defined anatomic lesion.”[15]

The AAFP Guideline now recommends chiropractic treatment for fibromyalgia, citing a pilot study by KL Blunt et al in which following four weeks of treatment, 21 patients with fibromyalgia improved compared with control subjects receiving medication only.[16]

Again, the mechanism of this improvement—the how and the why—may lie deep within the cranium initiated by spinal stress years before, but the evidence reveals that reducing back pain may decrease the intra-cranial degeneration at the core of this malady.

Like a Box of Chocolates

Just as there are over 200 treatments for LBP, there are almost as many chiropractic methods too. Presently there are 36 named chiropractic adjusting methods.[17] Undoubtedly most practitioners use a combination of these methods, so no two chiropractors are alike. Which type of method and practitioner should you use is a common question facing patients. The best advice is to ask your friends about their chiropractors. I have three chiropractors who I see on a regular basis. One of my favorites does extremity adjustments such as jaws, wrists, shoulders, knees, and feet. Another does my low back while the other does a great job with my old neck injuries. If you don’t like one, certainly try another until you find one that has the knack that you need.

As I’ve often said, “Chiropractors are like a box of chocolates, you just never know what you’ll get.” (With thanks to Forrest Gump).

If truth be told, chiropractors certainly are not alike, which is confusing to the public since we all have the same license to practice. Although MDs and attorneys have the same license, they still have specialties and so do chiropractors. Some DCs just high velocity, low amplitude methods that are the classic joint-popping methods, some DCs use non-force methods that never pop joints, many adjust the entire spine, while others only adjust the neck. Some specialize in LBP while others may treat only children. Some DCs practice nutrition and never adjust the spine while others do extensive spinal rehab.

Some DCs are primary care providers who mainly diagnose and refer while some from the old school of “straight” chiropractic only detect and correct vertebral subluxation and they ignore diagnosis or referral. Indeed, you just never know what type of chiropractor you may encounter, so it’s important to learn the particular type of DC before you consent to treatment.

 

The Big Controversy

I doubt any intelligent MD today would criticize chiropractors as specialists in non-drug, non-surgical spine specialists. The plethora of research is just too high now to dispute the effectiveness of chiropractic care for the vast majority of spine problems, especially the 97% of mechanical ones. Only a fool today would bash chiropractors with unfounded claims or trying to scare you with the voodoo diagnosis, telling you chiropractic care is dangerous, unscientific, or unproven.

The amount of evidence today is so great only an idiot or biased person would state such nonsense, but that still won’t stop some medical bigots who just can’t accept the new research. Old attitudes in medicine die hard and may take some 17 years to change as The National Academy of Science revealed.[18] For many in the medical community, the bias against chiropractors is 110 years old and will probably continue forever.

The single largest issue that remains subject to controversy between the medical and chiropractic communities is the scope of clinical effectiveness of DCs with non-back pain problems. This also remains an issue within the chiropractic profession between the evidence-based vs. faith-based factions, and it’s an issue that will not be resolved with the present level of technology in healthcare since it deals with the immaterial, not merely the physical.

Indeed, the Big Idea of chiropractic suggests the actual scope of chiropractic is as vast as the nerve system itself. The original Palmer father and son, DD and BJ, were not interested in low back pain or whiplash—the typical musculo-skeletal disorders that DCs commonly treat so successfully. Instead, the Palmers were interested in the function of the body’s organs and overall homeostasis via the nerve system. They were, in effect, among the earliest neuro-scientists who lectured on the affect of spinal dysfunction on neuro-anatomy caused by interference to the nerve system via vertebral subluxations.

The problem with the Palmer concepts was they were ahead of their time. Research could not explain their beliefs that the CNS controlled all function, and thus, interference to the nerve system created disease and dysfunction. Since the neuro-science at the time around 1895 was unsophisticated, concepts like “chronic low back pain is accompanied by brain atrophy and suggest that the pathophysiology of chronic pain includes thalamocortical processesweren’t available to explain the phenomenon of vertebral subluxations upon one’s health.

Consequently, the Palmers resorted to metaphysical terms to explain the neurological component of degenerative diseases. They spoke in terms of “nerve interference” and “innate intelligence” and other vitalistic terms to describe the mechanisms of dysfunction. Now science is catching up and explaining what the Palmers couldn’t do.

Certainly a big problem for the acceptance of this concept occurred when the Palmers refuse to accept other causes of disease when they stated their premise of “one cause—one cure—one correction” suggesting that only nerve interference was the sole cause of illness. Modern chiropractors reject that premise because there are many co-factors in the disease process, such as faulty nutrition, genetics, hormonal imbalances, stress, and obviously a range of germs and viruses.

The problem we chiropractors have with the medical profession is its refusal to consider that this is a legitimate cause of some disorders as the recent research has now shown. I’ve never understood how the medical professionals could deny that nerve interference might cause illness; indeed, this myopic attitude is more a tribute to their fundamental bias than a rational, scientific decision.

Dr. Paul Goodley, orthopedic physician and practitioner of manipulative therapy, also noted this bias among his colleagues when he coined a term, Fundamental Flaw in medicine.

“Eventually, while the schism's origin was lost like dark legend, the prejudice against manipulation self-perpetuated, and evidence was always available to justify this attitude. There have always been charlatans. So, instead of the manipulative fundamental dynamically developing as a cohesive, trustworthy guide within traditional medicine, it was discredited as the synonymous derelict symbol of its most despised competitor - chiropractic. And future generations born into a hardening tradition of pervasive belligerence against anything manipulative unquestioningly accepted this verdict.

“In 1972, I was visiting Rancho Los Amigos Hospital when Verne Nickels was chief of ortho and antagonistic to anything not. He had a glorious time revisiting the Symes amputation to prove its value after a century of being neglected. When I asked him why he wasn't expressing the same curiosity to rethink manipulation, he flared, "Because those who know the back cold say it doesn't work, SO IT DOESN'T!!!!!!!!!!!!!!!!"  I gave him a few seconds to recover from his apoplexy and asked him who knew the back that cold? If looks could kill.” [19]

Not only is there an inherent bias against manipulative therapy, compounding this is another Palmer belief of vitalism in the healing process. Vitalism, as defined by the Merriam-Webster dictionary, is a doctrine that the functions of a living organism are due to a vital principle distinct from physio-chemical forces. Obviously the medical profession, built on bio-chemical concepts of pharmacology and the mechanistic belief in surgery, have little room in its ideology for anything immaterial.

The original Palmer tenets suggested that not only does nerve energy flow along the nerves, but a life force does too. Any interference to this flow of life-sustaining energy will cause dysfunction and disease, not only pain. While the premise sounds plausible to some, it has never been proven in the science laboratory, although anecdotal evidence in DC offices has existed for 110 years.

I daresay every DC, evidenced-based or faith-based, can attest to some rather remarkable healing that transcends the explainable. The problem is it’s hard to base an entire profession on the unexplainable, which has led to strong criticism by medical professionals who are opposed to anything that appears faith-based healthcare.

This is the source of the strongest criticism of chiropractors: “They go too far when they claim chiropractic care can cure everything.” Apparently the public has an easier time accepting vitalism in chiropractic care. For example, in 1984, the Chiropractic Association of Oklahoma surveyed 400 households seeking their “attitudes toward chiropractic health care in Oklahoma.”[20] The results were interesting to say the least and provoking in what they revealed. Most interesting was that the more controversial aspects of chiropractic treatment and philosophy—the affect upon organic function and the concept of vitalism—was also very well received by the public.

“Some of the axioms around which chiropractic is structured are firmly believed in, and these are the ones which should be promoted more stringently since they will reach a higher degree of sympathetic belief. A particularly high number (over eight out of ten) agree that:

1. Once nerves are involved, almost anything can go wrong.

2. Bones in the spine can pinch or get out of alignment and affect    functions.

“Additionally, a very high number (71% to 75%) also agree that:

1. The spine can easily get out of alignment and affect functions

2. Nerves more than anything regulate function.

3. There is an unseen life force that cannot function unless all is in harmony.”

Even though most DCs do not make such claims at all, the few who believe in the power of the body to heal itself via the proper functioning of the nerve system have created an image that is both hard to support and hard to deny.

While most DCs principally work with musculo-skeletal disorders (MSDs), there also exists the vitalistic part of chiropractic practice that deals with the immaterial rather than the material. This aspect of chiropractic is the most controversial although it certainly can’t be ignored. The developer of chiropractic, BJ Palmer, and many of his disciples have made a pseudo-religion—chirovangelism—of this vitalism and this has been a source of controversy for over 110 years now.

For example, the past president of Life Chiropractic College, a Dr. Sid E. Williams, was quoted, “The only thing chiropractic can’t cure is rigor mortis.”

Of course, most MDs and DCs flinched at this idea and rightfully so. This has been the bane of rational chiropractors who deal with MSDs who must apologize for this banter. But to “straight” conservative chiropractors, this is their raison de'tat—their prime philosophy of practice—not to help with back pain, but to liberate the nerve energy that carries the life force to every cell in the human body.

In this vitalistic perspective, a spinal adjustment may reduce back pain, but it may hopefully reduce interference to the healing force of the nerve system. While science hasn’t proven this metaphysical concept, some anecdotal evidence in the field has shown some patient who have been helped with organic disorders.  Since vitalism stands opposed by medical mechanistic concepts, let me define and explain the chiropractic Big Idea.

Where vitalism explicitly invokes a vital principle, that element is often referred to as the "vital spark," "energy" or "élan vital," which some equate as “vital force.” Eastern traditions posited similar forces such as “qi” and “prana.” The most basic example is the energy that distinguishes living from non-living matter. Indeed, what is missing in a dead body? Every physical attribute is still there—the brain and nerves, the heart and blood, the bones, organs and muscles. Nothing is missing in a dead body except for the vital force that animates the living.

It’s next to impossible to speak of this metaphysical power to people who cherish the scientific principles—they want proof and the ability to duplicate it in the laboratory. Case studies, anecdotal evidence or folklore is not enough to convince these hard core scientists, even when the evidence is obvious.

NM Hadler, MD, author of “The Last Well Person,” scoffs at the vitalism found in some chiropractic enclaves.

 “What is less defined, somewhat contentious within the chiropractic, and very contentious for mainstream medicine is the purview of the chiropractic. Is it solely the regional musculoskeletal disorders? That is not the stance of many chiropractors or many schools of chiropractic. These advocates and practitioners are willing to ‘reduce subluxations’ for a range of ailments from headaches to asthma.”

“Subluxations are the chiropractic diagnosis that implies spinal malalignment. They are imaginary; no such specific skeletal changes correlate with symptoms…how anyone can imagine that such an event can salve asthma or diabetes or the like is a testimony to the tenacity of vitalistic theories.”

 

What Dr. Hadler suggests typifies the Fundamental Flaw of medicine—the ingrained dislike of any vitalistic concept, whether it’s by chiropractors or Traditional Chinese Medicine, or anyone who speaks of the energy within the body—that immaterial intelligence that animates the physical—including religious leaders who speak of the mind, faith, and soul in healing.

Hadler also may lack an understanding of the role of the Autonomic Nerve System in one’s health.

Joseph C. Keating, Jr., PhD, noted chiropractic historian, discusses vitalism's past and present roles in chiropractic and calls vitalism "a form of bio-theology" that he views vitalism as incompatible with scientific thinking:

“Chiropractors are not unique in recognizing a tendency and capacity for self-repair and auto-regulation of human physiology. But we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. So long as we propound the 'One cause, one cure' rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time. The purposiveness, consciousness and rigidity of the Palmers’ Innate should be rejected.” [21]

This is the conflict between evidence-based vs. faith-based chiropractors that has lasted for 110 years and will continue into the future. Many evidence-based DCs are torn with this dilemma, myself included. While I mainly treat MSD problems, on occasion patients will tell me of improvement with other health issues that were unexpected, such as getting pregnant! In fact, I’ve had seven women get pregnant after receiving spinal manipulation for LBP (that’s a special adjustment), but none of them came to me asking for treatment of their infertility. Other patients have told me of improvement with their blood pressure, asthma, bowel movements and some have told me their psyche is better, feeling less stressful.

While I cannot explain why this myriad of problems are improved other than to think of the immaterial healing force inherent to the nerve system—the “subtle substance of the soul” as BJ Palmer wrote—I do not bank of this treatment since in other cases the same conditions are not affected. There are too many co-factors in the healing process: the neurological, nutritional/bio-chemical, psychological, hormonal, physical, toxins/elimination, to name just a few of the many processes that control your overall health.

DD Palmer, the creator of the modern chiropractic profession, spoke of chiropractic not only in terms of the physical and meta-physical, but his main principle of chiropractic: Founded on Tone. He felt that proper tone in tissues was essential and it was affected by an imbalance between the sympathetic and para-sympathetic nerve systems. Each innervate every organ and muscle tissue and a 50-50 balance creates normal tonicity of these fibers.

It was Palmer’s contention that too much or too little will create a state of dis-ease in tissues and altered function.

“Life is the expression of tone. In that sentence is the basic principle of Chiropractic. Tone is the normal degree of nerve tension. Tone is expressed in functions by normal elasticity, activity, strength and excitability of the various organs, as observed in the state of health. Consequently, the cause of dis-ease is any variation of tone—nerves too tense or too slack.

“The nervous system is the channel thru and by which life-force—the energy which gives innervation to the essential functions of respiration and circulation—is transmitted. The two latter are the functions upon which life depends. They are carried on in proportion to the innervating force which, as we have noticed, may be either excessive or deficient, either condition causing disease and even death.

“The involuntary portion of the nervous system and muscles which contract by nerve stimuli must be in normal tone in order to execute the normal amount of functionating for a health existence.

“Excessive tonicity causes erethism, an abnormal increase of nervous irritability, an augmentation of vital phenomena in organs or tissue. Deficient tonicity causes atony or weakness, a lack of vitality.

“Tone is a term used to denote a normal degree of vigor, tension, activity, strength and excitability of nerves and muscles, as observed in a state of health—the effect of tonicity. Tonicity determines the tone. Excessive tonicity causes an augmentation of vital phenomena; a deficiency of tonicity, a want of tone, a loss or diminution of muscular or vital strength.”[22]

Chiropractic Cures All

Without question, the biggest objection by MDs toward chiropractors stems from the notion that chiropractic care helps patients in many situations, not just for neck/back pain and headaches—the common ailments patients seek help from DCs. Experienced DCs often see anecdotal cases of organic dysfunction improve in their offices, but science was unable to explain the how and why.  Perhaps now science is finally catching up to explaining the why and how spinal manipulation to remove back pain also may affect nerve function and overall homeostasis.

Part of the problem with MDs is their limited perspective of health. Being the supposed scientific profession that uses only mechanistic science to explain itself, health has become a description of MRI scans, blood analysis and other quantifiable tests. Indeed, most folks are fully aware of their blood counts such as cholesterol levels, triglycerides, and sugar levels, but they often miss seeing the forest through the trees.

What’s been lost today in medical science is the intangible element that focuses on the patient’s overall health. Terms such as vim, vigor and vitality are lost in today’s scientific arena since they cannot be measured, but they remain expressions of good health.

Even the medical analysis of an MRI or x-ray scan of the spine fails to see the overall alignment, strength, flexibility and weight-bearing capacity of the spine, instead searching for pathological lesions, such as disc abnormalities, fractures or infections. While MDs focus on these minutiae, chiropractors also look at the forest through these trees of abnormalities.

The brain research that now reveals that chronic back pain may lead to degeneration of the brain is a good example of finally seeing the forest through the trees. What may have begun as a common childhood fall off a bicycle that injuries the spine may later lead to a life of chronic back pain, which in turn may develop into fibromyalgia, chronic fatigue, post-traumatic stress disorder, irritable bowel syndrome, and depression as the researchers now suggest.

The Neuro-Science: PNS-ANS-CNS

 The understanding of the nerve system 110 years ago has certainly progressed and a short explanation might explain how the early chiropractic principals may come to bear some truth. Just as medical science has evolved from the days of blood letting, leaches and “bad spirits” as the causes of disease, today modern research may actually support the chiropractic principle of neuro-physiology as a cause of chronic degenerative disorders.

A simple lesson in neuro-anatomy may be helpful to the uninitiated. The central nervous system is that part of the nervous system that consists of the brain and spinal cord. The central nervous system (CNS) is one of the two major divisions of the nervous system. The other is the peripheral nervous system (PNS) which is outside the brain and spinal cord.

The peripheral nervous system (PNS) connects the central nervous system (CNS) to sensory organs (such as the eye and ear), other organs of the body, muscles, blood vessels and glands. The peripheral nerves include the 12 cranial nerves, the spinal nerves and roots, and what are called the autonomic nerves that are concerned specifically with the regulation of the heart muscle, the muscles in blood vessel walls, and glands.

 The autonomic nervous system (ANS) (or visceral nervous system) is the part of the peripheral nervous system that acts as a control system, maintaining homeostasis in the body. These activities are generally performed without conscious control.[23] The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils, urination, and sexual arousal. Whereas most of its actions are involuntary, some, such as breathing, work in tandem with the conscious mind.

It can be divided by subsystems into the parasympathetic nervous system and sympathetic nervous system.[24] It can also be divided functionally, into its sensory and motor systems.

What is autonomic failure?

Malfunction of the ANS is called autonomic failure. It results from an imbalance between the sympathetic and parasympathetic divisions. Aging is associated with several abnormalities in ANS function that can impair elderly people's adaptation to stress.[25]

Two chemical messengers (neurotransmitters), acetylcholine and norepinephrine, are used to communicate within the autonomic nervous system. Nerve fibers that secrete acetylcholine are called cholinergic fibers. Fibers that secrete norepinephrine are called adrenergic fibers. Generally, acetylcholine has parasympathetic (inhibiting) effects and norepinephrine has sympathetic (stimulating) effects. However, acetylcholine has some sympathetic effects. For example, it sometimes stimulates sweating or makes the hair stand on end.

Dysautonomia refers to a disorder of autonomic nervous system (ANS) function. Most physicians view dysautonomia in terms of failure of the sympathetic or parasympathetic components of the ANS, but dysautonomia involving excessive ANS activities also can occur. Dysautonomia can be local, as in reflex sympathetic dystrophy, or generalized, as in pure autonomic failure. It can be acute and reversible, as in Guillain-Barre syndrome, or chronic and progressive. Several common conditions such as diabetes and alcoholism can include dysautonomia. Dysautonomia also can occur as a primary condition or in association with degenerative neurological diseases such as Parkinson's disease.[26]

The most common signs of ANS impairment are:

·                     a drop in blood pressure when a person is standing or stands up suddenly (orthostatic hypotension) or

·                     a drop in blood pressure within one hour of eating a meal (postprandial hypotension).

The drop in blood pressure causes inadequate blood flow to the brain. That's why it's common for people with this problem to feel dizzy or lightheaded. These conditions occur more often in people with high blood pressure.

Several abnormalities make normal elderly people more likely to have low blood pressure. The onset of disease in old age, such as diabetes, stroke and Parkinson's disease, as well as medications used to treat them, may have other adverse effects in the ANS that are obvious in the cardiovascular system.

Patients with fibromyalgia have relentless hyperactivity of the sympathetic nervous system. This abnormality was also evident during sleeping hours. In a different study, patients with fibromyalgia to a simple stress test (to stand up) were observed to have a paradoxical derangement of the sympathetic nervous system response to the upright posture. Such findings have been confirmed by other groups of investigators.[27]

The results of these studies suggest that a fundamental alteration of fibromyalgia is a disordered function of the autonomic nervous system. Patients with fibromyalgia lose the normal day/night cycles (circadian rhythms) and have a relentless sympathetic hyperactivity throughout 24 hours. This may explain the sleeping problems that the patients have. At the same time, such individuals have sympathetic hypo-reactivity to stress, which could explain the profound fatigue, morning stiffness and other complaints associated to low blood pressure. This autonomic nervous system dysfunction could induce other symptoms of fibromyalgia such as irritable bowel, urinary discomfort, limb numbness, anxiety and dryness of the eyes and mouth. 

Fibromyalgia’s defining features (chronic widespread pain and tenderness to palpation) could be explained by the mechanism known as “sympathetically maintained pain”. After a triggering event (physical/emotional trauma, infections) relentless sympathetic hyperactivity may develop in susceptible individuals. This hyperactivity induces excessive norepinephrine (also known as noradrenaline) secretion, that could in turn sensitize central and peripheral pain receptors and thus induce widespread pain and widespread tenderness. Exquisite tenderness at palpation (its medical term is allodynia) is a typical sympathetically maintained pain feature.

Disorders of the autonomic nervous system can affect any body part or process. Autonomic disorders may result from other disorders that damage autonomic nerves (such as diabetes), or they may occur on their own. Autonomic disorders may be reversible or progressive.[28]



[1]Tachihara H, Kikuchi S, Konno S, Sekiguchi M. Does facet joint inflammation induce radiculopathy?: an investigation using a rat model of lumbar facet joint inflammation. Spine. 2007 Feb 15;32(4):406-12.

[2] Rome, PL. Usage of chiropractic terminology in the literature: 296 ways to say "subluxation": complex issues of the vertebral subluxation. Chiropractic Technique, 1996:8(2)49-60.

[3] A. Vania Apkarian et al. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density

The Journal of Neuroscience, November 17, 2004, 24(46):10410-10415.

[4] Paulozzi LJ, Trends in unintentional drug overdose deaths, Testimony to the U.S. Senate Committee on the Judiciary, March 12, 2008.

[5] Licciardone JC, The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States, Osteopathic Medicine and Primary Care, 2008; 2(1);

[6] Von Korff M and Deyo RA, Potent opioids for chronic musculoskeletal pain: Flying blind? Pain, 2004; 109:207–9.

[7] P. Schweinhardt, K. M. Sauro, and M. C. Bushnell Fibromyalgia: A Disorder of the Brain? The Neuroscientist, Vol. 14, No. 5, 415-421 (2008)

 

[8] Marwan N. Baliki, et al. Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics

The Journal of Neuroscience, February 6, 2008, 28(6):1398-1403.

[9] Anil Kuchinad et al. Accelerated Brain Gray Matter Loss in Fibromyalgia Patients: Premature Aging of the Brain? The Journal of Neuroscience, April 11, 2007, 27(15):4004-4007

[10] A. Riftine, clusterization of the relationship between sympathetic and parasympathetic activity by heart rate variability analysis for risk stratification of sudden cardiac death, Heart Rate Variability Institute, Edison, NJ, USA.

[11] Ozcan Ozdemir, MD, et al. Increased Sympathetic Nervous System Activity as Cause of Exercise-Induced Ventricular Tachycardia in Patients with Normal Coronary Arteries  Tex Heart Inst J. 2003; 30(2): 100–104.

[12]Gregory M. Eaton, MD et al. Early Left Ventricular Dysfunction Elicits Activation of Sympathetic Drive and Attenuation of Parasympathetic Tone in the Paced Canine Model of Congestive Heart Failure ,Presented in part at the 65th Scientific Sessions of the American Heart Association, New Orleans, La, November 16-19, 1992.  Circulation 1995;92:555-561.

[13]David M. Brady, DC, Michael J. Schneider, DC, A new paradigm for differential diagnosis and treatment, Volume 24, Issue 8, Pages 529-541 (October 2001).  

[14] Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers, 2nd Edition, 2008 revision.

[15] Millea P &  Holloway R, Treating Fibromyalgia , Amer Family Physician - 2000 Oct; 62(7).

[16] Blunt KL, Rajwani MH, Guerriero RC. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manipulative Physiol Ther 1997;20:389-99.

[17] Leach, RA, The Chiropractic Theories: A Textbook of Scientific Research, Table 1.1, ed.4. Baltimore: Lippincott, Williams & Wilkins, 2004:8.

[18] Crossing the Quality Chasm: A New Health System for the 21st Century, The National Academy of Sciences, 2001. page 13-14.

 

[19] Goodley, Paul, author of “Release from Pain”, www.DrGoodley.com

 

[20] Welling & Company and the Oklahoma chiropractic research foundation in cooperation with the chiropractic association of Oklahoma in 1984 that surveyed the “attitudes toward chiropractic health care in Oklahoma”

[21] "The Meanings of Innate," Joseph C. Keating, Jr., PhD, J Can Chiropr Assoc 2002; 46(1)

[22] Palmer, DD, The Chiropractor’s Adjuster, Portland Printing House Company, 1910.

[23]autonomic nervous system at Dorland's Medical Dictionary.

[24] eMedicine/Stedman Medical Dictionary Lookup!". Retrieved on 2008-11-30.

[25] 2008 American Heart Association, Inc., www.americanheart.org

[26] Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892.

[27] Martinez-Lavin M, Hermosillo AG, Mendoza C, et al. Orthostatic sympathetic derangement in individuals with fibromyalgia. J Rheumatol 1997;24:714.

[28] http://www.merck.com/mmhe/sec06/ch098666/ch098666a.html

Website Builder