By Douglas Pooley and Keith Thomson
An attempt to identify what it is that makes chiropractic valuable
By Douglas Pooley and Keith Thomson
We used to hate the term subluxation as it applied to chiropractic treatment. That whole “bone out of place” thing just didn’t resonate with us. After all, we are a science- and evidence-based profession. For most of my 39 years in practice, we held firm to the tenant that the purpose of chiropractic treatment was to correct biomechanical dysfunction in the spine and related joints.
Recently we read the Ontario Chiropractic Association’s definition of chiropractic practice, which states:
“Chiropractors practice a manual approach, providing diagnosis, treatment and preventive care for disorders related to the spine, pelvis, nervous system and joints.
Chiropractors use a combination of treatments, all of which are predicated on the specific needs of the individual patient. After taking a complete history and diagnosing a patient, a chiropractor can develop and carry out a comprehensive treatment/management plan, recommend therapeutic exercise and other non-invasive therapies, as well as provide nutritional, dietary and lifestyle counselling.
Chiropractic care is frequently the primary method of treatment. Where other conditions exist, chiropractic care may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition.
Chiropractic care may also be used to provide symptomatic relief for patients with chronic conditions. According to patient surveys, by treating the musculoskeletal elements of such disorders, chiropractic treatment has been shown to improve the general well-being of the patient.”
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We looked hard at what was written and then held it up against what we actually do in practice. We noticed that there were a couple of very important and defining components of our practice missing, such as reference to mechanical interference in the spine being a cause or at least related to anything, or that the adjustment serves as an effective tool to correct. Where are the defining components that tell the consumer what they are getting if they decide to purchase the service? Aspects of that very same definition used by the OCA could be used to describe physiotherapy, osteopathy, naturopathy, or massage therapy. It forced an instant pause as we realized all the major players in health care were instantly recognized by what they do and how they do it. There is no doubt what a dentist does, or an optometrist, psychologist or a medical doctor. The name and the core services provided are self-evident.
So, why does chiropractic not enjoy purposeful recognition? And has our lack of clear definition and purpose served to diminish the profession competitively? It is only logical to assume yes. With this in mind, we dismantled the profession in an attempt to identify what it is that makes us valuable, what our core purpose is, what separates us from competitors and what unique service provision defines us to consumers.
Dismantling the profession
What makes us valuable was easy: No other profession has the tools to maintain the integrity of the neuromusculoskeletal system better than a chiropractor. Purely from a biomechanical efficiency perspective, we are the best equipped to cost effectively asses, correct and maintain efficiency of movement. We firmly believe that if money was not a factor, consumers would use chiropractic services more often. To prove the point we did a “straw poll” in our offices where we asked that question of existing patients. The results were that 87 per cent of existing patients would use the services more often.
As to what our core purpose is: We believe that 39 years in practice has demonstrated that our purpose is to maintain efficiency of movement which in turn results in reduction in related symptoms, the lessening and often reversal of wear and tear associated with injury with a balancing of autonomics to maximize adaptive capacity. Ten years ago if someone would have said this we would scoffed and demanded the science. Now, the evidence is there, but more importantly clinical practice proves the truth of it.
What separates us from competitors is our understanding of the impact that efficient function of the spine and related joints has upon movement, and most importantly the massive impact that efficient movement has upon health. Again, science continues to demonstrate the unassailable correlation between degree of movement and prevalence of disease. Quite simply, the less mobile people are, the more they are susceptible to all major diseases, and chiropractic care maintains balance and mobility.
We wrestled with what it really was that uniquely defines us to consumers, and this is where the rubber really hits the road because we believe this establishes our identity. We seek to correct neuro-biomechanical dysfunction through the adjustment of the affected joint or joints to impact function/adaptability. This is what brings us back to the term “subluxation.” When you boil it down, chiropractors adjust subluxations. This is our distinctness and what separates us from everyone else in health care. When properly understood and defined, the term subluxation perfectly describes what we seek to identify and correct. The term adjustment properly defines the procedures used by chiropractors to treat subluxation. The science and the logic are there. Subluxation is a chiropractic term – the adjustment, a chiropractic procedure. We are a unique and valid profession with a distinct purpose and value to consumers. Growth will only come from championing our uniqueness, not sharing in the mediocrity.
DR. Douglas Pooley graduated from the CMCC and has practiced in St. Thomas, Ont., for the past 39 years. He has represented the profession on national and provincial boards and has lectured nationally and internationally.
DR. Keith Thomson is both a chiropractor and a naturopathic doctor. He is a former president of the College of Chiropractors of Ontario. He has been in practice in Peterborough, Ont., for almost 40 years.