Time for Chiropractic to Evolve?
Science or Philosophy
I recently searched the internet for scientific evidence to support chiropractic. To my dismay, almost every listing—page after discouraging page—was filled with negative reviews and commentary on the lack of scientific validation or measurable outcomes to support the basic tenets of our profession. At best, a few articles demonstrate a slim advantage for chiropractic over some prescription medications for the relief of pain in certain conditions.
I have been a chiropractor for more than 41 years, but early in my career, I became convinced that I was not achieving the kinds of results promised when I at-tended school. I also witnessed many of my colleagues becoming disheartened or failing in practice. They had come into this profession with high expectations and a sincere desire to help their fellow humans, but the types of treatments they had been taught did not live up to these expectations.
Like many of you, I pursued a long search for additional modalities to improve my results, validate my outcomes, and give me the confidence to be able to find and resolve my patients’ conditions. In this search, I was blessed to meet several researchers and clinicians from other fields (cell biology, biomedical engineering, orthopedic medicine, osteopathy, and physical medicine) who were making amazing discoveries regarding the underly-ing effects of injury and biomechanical dysfunction at the cellular, bioelectrical, and even the molecular level. I recognized that, in order for a system of therapeutics to be valid, it had to be congruent with this emerging science.
Startling Observations: Bone Enlarges with Injury!
While studying radiology in chiropractic school, I noticed that the size of a structure on one side of the body was occasionally different from its opposing counterpart. For example, the proximal femoral or humeral head or the tibial plateau on one side was noticeably larger than the opposite side in the same individual. My professors were unable to shed any light on these findings. As an anatomy lab instructor at the college, and from subsequent observations of cadaverous specimens, I was able to confirm these differences. At the time, these facts were simply filed away, and many years later, these early observations came to be viewed in a new light based on my own clinical research.
Figure 1: Model of C1, cast from a real skeletal specimen. Note the enlargement of the right articular pro- cess and the spinal canal, which measured 2 mm. larger in every dimension.
By carefully examining a better quality skeletal model, which is cast from a real skeleton, you can verify for yourself many of these same discrepancies. Besides the examples of the femur, tibia, and humerus mentioned earlier, a close inspection of the spine could be very re-vealing. Note the differences in the size (width, depth, and height of the articular processes) at various levels throughout the spine. Figure 1 demonstrates these differences in the size of the articular processes of the atlas. It is my contention that, on palpation, these areas of enlargement may be easily mistaken for a relative rotation or translation of the vertebral segment (see A Case of Mistaken Identity below).
Figure 2: Microscopic Evidence of Bone Expansion with Injury, Paul Hansma Lab, University of California, Berkeley, 2005. (with permission from the author)
Recent evidence from the University of California, revealed by the powerful atomic force microscope under the direction of physicist Paul Hansma and his team[1], has confirmed the presence of certain protein structures within bone that expand with injury. These findings are consistent with my clinical observations, which were made more than 40 years ago (see Figure 2).
Restoration of Bone Size and Joint Healing
One of the major clinical break-throughs that my colleagues and I were able to accomplish was that bone size appeared to be restored to normal with treatment. At first, we questioned these results and followed them up with precise measurements using calipers and tape measures. Inter-tester validation appeared to confirm our findings.
Several years ago, I treated a 15-year-old male hockey player who had been suffering with knee pain for several months, which not only prevented him from playing but also caused considerable pain during normal daily activities, such as climbing stairs, which he was only able to accomplish in a slow, hobbling manner. Fortunately for me, orthopedic surgeons were monitoring the size of the bones at the knee with a high degree of precision due to an underlying genetic condition. As a result, they took consistent measurements to within one-hundredth of a millimeter. They were all surprised when the femoral condyle and the tibial plateau of the left knee, which had been approximately 5 mm larger than its counterpart on the right, had suddenly shrunk by that amount after only a few treatments (see Figure 3 and 4 below). Subsequently, the young man’s parents noted that he was once again “flying up the stairs” with absolutely no pain. This case verified my contention that normalization of the shape of the bone is possible and appears to allow for the restoration of the joint space and the potential regrowth of articular cartilage, resulting in more complete healing of the entire joint complex.
Figure 3: Femoral and tibial epiphyses enlarged, approximately 5mm. compared to the right. *Note relative narrowing of the medial joint space.
Figure 4, Post-treatment: Femoral and tibial epiphyses restored to same size as the right side, following treatment. *Note opening of the medial joint space.
Subluxation: A Case of Mistaken Identity?
The subluxation theory and the idea that bones “go out of place” has long been refuted. However, it is my belief that the entire premise may simply be a matter of mistaken identity. By this, I mean that the palpatory evidence of misaligned vertebra and the fact that many patients achieve benefit through chiropractic adjustment may, in fact, be due to some degree of influence on the structure of the osseous portion of the vertebral segment, albeit inadvertently, on the part of the practitioner. I am now of the opinion that if practitioners were made aware of the fact that in-jury actually alters the shape and size of bone in the spine and throughout the body, they would eagerly apply methods that would more precisely target these areas and thus achieve even better results.
Neurological Evidence
One of the major factors that drew me to chiropractic in the first place was its emphasis on the central importance of the nervous system. This made absolute sense to me because a disruption of neurological signals to any area of the body could lead to serious functional consequences and even survival. The unique anatomical structure of the spine is exquisitely designed to afford substantial protection to the spinal cord while still allowing for mobility and flexibility. However, it was always a mystery to me why there was never any mention in the chiropractic literature regarding the most significant concentration of neurons in the body, which are housed in the equally protective structure of the cranium. It was only when I embarked on a study of osteopathic medicine that I realized how profound this omission was. The more I investigated this import-ant aspect of human anatomy and the common injuries that can often lead to life-altering outcomes, the more I recognized how important it was for me to incorporate a rational approach to treatment of this area.
By applying the principle of identifying and normalizing the structure of the cranial bones, as with other areas of the body, we have witnessed a remarkable degree of success in helping individuals recover from many devastating neurological consequences, including cognitive, visual, auditory, vestibular, and neuromuscular conditions. Several independent researchers have verified these outcomes.[3],[4]
Dr. Norman Doidge, MD, who is on faculty at Columbia University and the University of Toronto, is a world-renowned expert in the field of brain injury and neuroplasticity. After hearing about our approach, he conducted an in-depth investigation, which included observations of treatments, patient interviews with numerous concussion and post- concussion patients, and participating in the training program himself. In his recent bestselling book, The Brain’s Way of Healing, he commented, “I view it as prudent to have a Matrix assessment after a blow to the head... observing such cases has led me to hope that soon, Matrix Repatterning will be routinely applied in hospital emergency departments.”[2]
The Evolution of Chiropractic
Through a combination of relentless questioning and evaluation of measurable, objective changes (biomechanical, structural, radio-graphic, biochemical, and neurological) in my own practice and those of my students and colleagues, I was gradually able to evolve a method to identify and resolve many of the osseous (and other fascial) effects of injury and thus improve our clinical outcomes. Over the years, this protocol has been recognized by a grow-ing number of chiropractors, as well as clinicians and researchers from various fields. I have been gratified to note that many of them have been able to reproduce the same measurable outcomes, which I observed.
My goal has always been to find measurable evidence to support any of the techniques we, as chiropractors, provide. I have often wondered how things might be different if our profession were to embrace and integrate the latest developments in cell biology, molecular biomechanics, biomedical engineering, and bioelectricity.[4],[5] These emerging disciplines are crucial to our understanding of the effects of injury at the most fundamental level of the human body. It is my belief that these scientific advances would support much of what we already provide and help us evolve even further as a truly science-based profession. I sense that there is a growing desire among many in our profession to see chiropractic take its rightful role in the healthcare industry as a leader in the field of physical medicine. The way ahead will benefit not only our profession but also the countless individuals who are looking for real solutions for many painful and limiting conditions.
REFERENCES:
1 Fantner GE, Hassenkam T, Kindt JH, Weaver JC, Birkedal H, Pechenik L, Cutroni JA, Cidade GA, Stucky GD, Morse DE, Hansma PK. Sacrificial bonds and hidden length dissipate energy as mineralized fibrils separate during bone fracture, Nat Mater. 2005 Aug;4(8):612-6. Epub 2005 Jul 17. [Return to article.]
2 Doidge, N., The Brain’s Way of Healing, Penguin Books, New York, 2016. [Return to article.]
3 Tommerdahl, M, Dennis, RG, et al., Neurosensory Assessment of Concussion, Mil Med. 2016 May;181(5 Suppl):45-50. [Return to article.]
4 MacGuintie LA, Streaming and piezoelectric potentials in connective tissues, In: Blank M (ed) Electromagnetic fields: biological inter- actions and mechanisms. Advances in Chemistry Series 250. American Chemical Society, Washington DC, ch. 8, pp 125-142, 1995. [Return to article.]
5 Chakkalakal DA, Mechanoelectric transduction in bone. J Mater Res. 1989;4: 1034-1046. [Return to article.]
