A significant controversy has surrounded the ‘chiropractic paradigm’ since D.D. Palmer first postulated the concept of spinal subluxation in his early 20th century writings. As a consequence, chiropractors have had a difficult time defining their roles in the evolving health care landscape dominated by best-practices and evidenced-based research. For years, chiropractors have maintained that at their philosophical cores, they serve humankind by detecting and correcting spinal subluxations or focal vertebral joint dysfunctions, which are postulated to attenuate some vital neurological force that is essential for survival. Traditional chiropractic philosophy argues that free from the neurological constraints caused by these subluxations, our body’s innate ability to heal and grow can express itself and free us from sickness and disease.
While this simple model seems to get to the heart of the communal chiropractic identity, it has been shown to fail under the weight of scientific scrutiny. Throughout the years, chiropractors have wrestled with the identity crisis inherently caused by their scientifically flawed world-view, as is evidenced by the now clichéd disunity between so-called ‘mixer’ and ‘straight’ practitioners. The aforementioned have elected to forsake their philosophical roots to pursue more evidenced sensory techniques for symptom relief such as physical therapies, soft-tissue interventions and rehabilitation while the latter have staunchly maintained a principled approach to holistic care by addressing only spinal subluxations as dictated by D.D. Palmer and, later, his son B.J. Because of an essentially universal scope of practice that allows chiropractors to perform manual manipulative techniques in every state in the US, often the argument about what doctors of chiropractic choose to do to address patient complaints in their respective offices becomes a matter of semantics and egos. However, as we’re beginning to see through advances in neuroscience, such semantic arguments may soon become moot.
In any form, chiropractic care is essentially sensory-based medicine designed to stimulate a receptor-driven neurological construct. Chiropractors bombard patients’ nervous systems with stimuli with the intention of creating positive change without having to use pharmaceuticals. In that regard, both ‘straight’ and ‘mixer’ approaches have valid usefulness. The intention and approach to application, as it turns out, is more important than the application itself. Non-chiropractic neuroscientists such as Paul Bach-y-Rita, Mike Merzenich, Edward Taub and Vilayanur Ramachandran as well as scientists inside the profession such as Heidi Haavik-Taylor, Burnadette Murphy and Frederick Carrick have begun to show that the human nervous system is in fact an incredibly dynamic and plastic environment that is heavily influenced by sensory input and receptor potentiation. In short, the brain has been shown to change permanently under the influence of outside forces, such as, say, a chiropractic adjustment, which sends massive amounts of afferent input into the spinal cord, brainstem, cerebellum and cerebral cortex. In this regard, it is not too much of a stretch to see how D.D. Palmer’s original subluxation concept may be have been partially accurate in spite of it’s crudeness. Chiropractors who choose to use additional sensory techniques such as massage, electric stimulation and ultrasound, to name a few, to address subclinical neurological compromise including spinal subluxations are essentially performing treatments in line with traditional chiropractic philosophy without acknowledging it.
A wide and variable scope of practice is, therefore, clearly not a detriment. Since Carrick’s first works, chiropractors have been convincingly shown to be the gatekeepers of neurological well-being in terms recognized by leading non-chiropractic neuroplasticians, regardless of their specific mode of intervention. In this regard, chiropractors have taken perhaps an unintended step away from their traditional role as spine specialists. True, chiropractors address mostly spinal complaints due to the intrinsic and powerful relationship the spine has with the central nervous system, but in reality they treat disorders relating to central neurological integration errors created by cultural, social and genetic maladaptation. In light of the current healthcare renaissance, it is vital that chiropractors embrace this functional appreciation for the care they provide. Regardless of scope, chiropractors must differentiate themselves from physical therapists and physiatrists whose roles may at times overlap. Whether we embrace wellness, pain management or preventative spine care, the intent we bring to our craft delineates our uniqueness. Varying scopes of practice fail to weaken our core philosophy as long as we remain mindful that we serve our patients by acknowledging the research that supports our paradigm and by appreciating the fact the tools at our disposal necessarily classify us as functional nervous system specialists regardless of the techniques we use or outcomes we seek.