Letter to the Editor: A response to "What is Chiropractic?"

Dr. Samantha R. Colautti
August 12, 2019
Written by Dr. Samantha R. Colautti
I read with interest the article by Dr. Joe Ghorayeb DC, MHA entitled, “What Is Chiropractic?”.
The definition of what chiropractic ‘truly is’ has been debated probably since the day the first class of chiropractors graduated over 100 years ago and has been a topic of fevered discussion ever since. I appreciate Dr. Ghorayeb’s contribution to the discussion less because I agree, necessarily, with his definition but more because his article answered the question that has been plaguing me for the past decade – namely why are new graduates from CMCC so averse to performing spinal manipulation?

As an alumna of CMCC’s Class of ’99 the questions that were volleyed between my peers as graduation approached were more along the lines of whether we would have open or closed adjusting suites or which adjusting techniques we would offer. The fact that we would dedicate our professional lives to adjusting the spine (or performing spinal manipulative therapy) was never a question. I have noticed that it is different with new grads. 

Now, the most common questions I hear revolve around whether, or not they are certified in ART (Active Release Technique) or acupuncture yet. Yet. The focus invariably seems to be on therapies such as these, exercise prescription and/or nutritional supplementation exclusively. I have come to understand that students deemed “overly” interested in learning how to perform spinal adjustments are given the pejorative name “subbies” and are looked upon with derision. While I will acknowledge that even during my time at CMCC there was some friction between those who considered themselves “principled” chiropractors and others, there was never any doubt that our common focus was to find and correct spinal misalignments for the betterment of our patient's health and well-being. The language used to express that sentiment could vary, but the sentiment was shared nonetheless. The idea that the focus of our profession is steadfastly turning away from the study and perfection of the spinal adjustment in favour of becoming an amalgam of the already established professions of physiotherapy, massage therapy, naturopathy and certified athletic trainer is harrowing.

I have enjoyed 20 years of practice in a small town in Southern Ontario and have adjusted, manipulated, or cracked (I don’t care what you call it) the spines of thousands of wonderful people of all ages (from newborns to those in their 90's) and have seen the most incredible, borderline miraculous changes in many of their states of health and well-being, both physical and mental. I am humbled and constantly grateful to be able to play a role – sometimes large, other times small – in the pageantry of life in my community and to be able to affect a change for the better by offering a service at a level of skill and professionalism that no other profession can, to the very best of my ability, daily.

Is the chiropractic adjustment some sort of much-maligned cure-all? Certainly not. Does making restricted areas of the spine move properly again (however you describe that) through the use of a high velocity, low amplitude thrust (however you choose to describe or administer that) result in changes in a patient’s actual and perceived pain and dysfunction? Undeniably, yes.

The argument that there is little research available to define and describe what we are doing can rightly be seen as a stumbling block to those who need to know (I can count myself among them). That this should be used as a reason to discount and discredit over a century of positive outcomes is, I believe, a mistake. I wonder if Dr. Ghorayeb and others like him misinterpret an absence of proof as a lack of proof? The former is the natural consequence of no one looking for answers while the latter would imply that a thorough search yielded no answers. My personal feeling is that the paucity of research-based evidence should be a call-to-action for the profession to perform the necessary studies. After all, anecdotal evidence for the use of chiropractic adjustments to alleviate unnecessary suffering of myriad types is overwhelming and CMCC, with its long history of performing world-class research, would seem to be ideally suited to take up the mantle. Unfortunately, if Dr. Ghorayeb’s perceptions of our profession and the attitudes and practices of the new graduates I’ve met are indicative of the current administration’s culture at large, it will take a paradigm shift of mammoth proportions to affect any sort of change in the direction I would consider positive.

In the meantime, I would suggest to Dr. Ghorayeb (and others) that should he wish to better understand chiropractic as it has been practiced classically, he would do well to attend a lecture from Dr. John Minardi BHK, DC or invest in his DVD lecture series on the neurology of the subluxation and chiropractic’s effect on health. Or, read research published by Dr. Heidi Haavik BSc, PhD, DC or Dr. Joyce Miller BSc, DC, FACO, FCC (UK). I would further suggest that chiropractic students take the time to shadow those of us with established practices to view firsthand the difference chiropractic spinal adjustments can make to the lives of our fellows. Trust me, it would be time well spent.

Finally, I thank Dr. Ghorayeb for his well-written and thought-provoking article. However our opinions of chiropractic may differ, I wholeheartedly agree that “chiropractors ought to focus on enhancing human adaptability and resilience, in addition to promoting self-efficacy, while recognizing the role that biological, psychological, and social factors play in influencing the patient experience and the potential indications for administering specific treatments.” To me, that will always be achieved first and foremost by the correct application of the spinal adjustment and I agree with Drs. Pooley and Thomson who wrote a year ago that “growth [of our profession] will only come from championing our uniqueness, not sharing in the mediocrity”. My fervent wish is that this sentiment continues to be shared and nurtured by our profession for centuries to come.

Yours with the greatest respect,

Dr. Samantha R. Colautti

Hons. BSc., DC

Comments  

 
+6 #33 Joe Ghorayeb 2019-09-10 10:23
Dr. Toe,

If a patient engaging in a physical rehabilitation program performs exercises under the supervision of a physiotherapist or a chiropractor, does that patient heal faster visiting one provider over another?

This is the essence of what you are asking and it is nonsensical.

I do understand the point you are trying to make, which is that you believe in order for chiropractic to flourish it must be unique. I disagree. Instead, it is my view that if chiropractic and physiotherapy are viewed on par with one another, chiropractors would realize greater practice opportunities in hospitals and other group settings along with increased referrals from medical professionals and ultimately increased utilization of services.

The close-minded "us vs. them" mentality has to end. Pain is a universal perception that is nondiscriminato ry and can be managed by a wide variety of practitioners. Open your mind to the possibilities of inclusion.
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+6 #32 Joe Ghorayeb 2019-09-10 09:58
Quoting Dr toe:
Dr. Joe,
Without getting into the research, if a person is facing two doors in a strip mall, one says physiotherapist and the other chiropractor, what would make that person walk through the one door and what would make them walk through the other?


Dr. Toe,

Without getting into the research, if a person is facing two doors in a strip mall, one saying physiotherapist and the other saying chiropractor, that person should walk through the door of the clinic that can accommodate his/her schedule for an appointment. If both clinics can do this, then it is a coin toss. There is no real distinction between evidence based chiropractic and evidence based physiotherapy. Your reluctance to appreciate and understand this is concerning as this nonsensical debate has to end. Pain is a key motivator for people to visit either a chiropractor or a physiotherapist and both professionals can do a great job in pain management.
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0 #31 Dr toe 2019-09-09 22:59
Dr. Joe,
Without getting into the research, if a person is facing two doors in a strip mall, one says physiotherapist and the other chiropractor, what would make that person walk through the one door and what would make them walk through the other?
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+25 #30 Joe Ghorayeb 2019-08-27 16:47
Quoting Dr. John Toe:
What "evidence" and if we are judging our evidence against i.e. medicine, research their evidence versus what they are doing clinically and just because the research doesn't prove something, that doesn't mean it doesn't work, otherwise your and my patients would not return.


Context is important here. What do you mean by “work”? If you mean to provide symptomatic relief you will note that I have no argument. My argument is that for chiropractic to thrive as a profession, its practitioners need to embrace evidence based care. My article clearly struck a nerve with you and others. Perhaps if you “unsublux” yourselves, you may think more clearly and will be able to appreciate the intent of my article.
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+25 #29 Joe Ghorayeb 2019-08-27 16:31
Quoting Dr. John Toe:
Dr. Ghorayeb,
Your statement "The general public should sense no difference between an evidence based chiropractor or an evidence based physiotherapist..." is exactly the issue. If the public and government can not see any difference between professions, the profession which is smaller and less vocal, will disappear. As more chiropractors treat patients without any difference from physiotherapists, the profession will eventually cease to exist.


What voice do you wish to project? The research evidence clearly demonstrates that SMT, which is not exclusive to chiropractic, is inferior to exercise as a treatment modality. Your position is to ignore the evidence. Who do you expect to take your seriously?
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+26 #28 Joe Ghorayeb 2019-08-27 16:23
Quoting Dr Don Robinson:
When asked for references, I point to my 40 years of dramatic results and referring patients. I built a strong relationship with MDs and some became patients after seeing results beyond the MS limitations. Any conflict with "research" reveals a deficit in the research (bias, lack of original research etc),education, or skills of the research adjuster.


So what you’re saying is that your personal experience, which carries with it your personal biases, trumps years of research findings...inte resting.
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-26 #27 Dr. John Toe 2019-08-27 11:25
Dr Don Robinson,
Thank you for writing in, we need more people doing this.
I agree 100% with all you have written.
I have been practicing over 20 years, using 95% hand adjustments, a bit drop table and a bit activator, soft tissue work with my hands and exercises for patients. As with you, I see many referrals and I am very comfortable with my numbers. I agree with you about our research and I find the "norm" now is to use the phrase "evidenced based". What "evidence" and if we are judging our evidence against i.e. medicine, research their evidence versus what they are doing clinically and just because the research doesn't prove something, that doesn't mean it doesn't work, otherwise your and my patients would not return.
I thank you for your years of helping people. Continue to know you treated people correctly proven with their smile and their "thank you".
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-25 #26 Dr Don Robinson 2019-08-27 09:31
Dr Toe, Thank you for your comments. Chiropractic without SMT as a primary focus will die. Retired now, I worked 40 years in my basement office seeing 200 patients/wk without advertising or self-promotion. No white coat or fancy office or equipment. No canned speeches or impressive forms. Just 2 hands with a respect and admiration for the uniqueness and value of a spinal adjustment. Ultrasound was the only adjunct used (also now in disrepute). I also obtained my FCCRS,(very evidence based & research oriented). When asked for references, I point to my 40 years of dramatic results and referring patients. I built a strong relationship with MDs and some became patients after seeing results beyond the MS limitations. Any conflict with "research" reveals a deficit in the research (bias, lack of original research etc),education, or skills of the research adjuster.
I am saddened and angered to see the dismissal of experience, and the arrogance and condescension of misguided knowledge.
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-29 #25 Dr. John Toe 2019-08-27 08:19
Dr. Ghorayeb,
Your statement "The general public should sense no difference between an evidence based chiropractor or an evidence based physiotherapist ..." is exactly the issue. If the public and government can not see any difference between professions, the profession which is smaller and less vocal, will disappear. As more chiropractors treat patients without any difference from physiotherapist s, the profession will eventually cease to exist.

I appeal to others reading this string to voice their position. The use of SMT with or without modalities or exercise is at the base of the topic "What is chiropractic" and " where is the profession going".
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+26 #24 Joe Ghorayeb 2019-08-26 12:49
Dr. "Toe" (and others), before you retort: "well how do we distinguish chiropractic from physiotherapy?" - my position is that a distinction is not necessary, in the same fashion that MDs and DOs in the U.S. do not feel the need to distinguish themselves from one another.

The degree you have acquired reflects the path you took to attain your current position, but the quality of your work is reflected in your knowledge and skills as they comport with the best available evidence at this time.

I had hoped that our discussions would be more substantial, but unfortunately it seems that the individuals opposing the views described in my article are unable to support their position(s) with evidence.

Thank you for the lively discussion. This will be my last post in regard to this matter.
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