Chiropractic Is Not What It Used To Be
Chiropractor in Amarillo TX discusses the changes
Chiropractic is not what it used to be. That's quite a title and I am sure I have fellow chiropractors reading with a skeptical eyebrow raised from the start. If I have had a problem my whole life, it has been that I tend to speak my mind rather than suppress my thoughts. Sometimes that is an excellent trait. Sometimes it is not. Ultimately, my goal is to educate my population to the best of my ability using the knowledge I have gained in over 23 years since I graduated chiropractic school, and that is where we will begin.
When I graduated from Parker College of Chiropractic in 1997, the school was full of amazing classes. Many don't have many reasons to be aware of a chiropractor's education but we literally have the exact same course load that is found in medical school. It is still like that. Chiropractors have a challenging course load.
- Gross Anatomy - dissecting human cadavers
- Cell Biology
- Bone Pathology
- Systemic Anatomy
These are just a few of the ridiculously hard classes we conquered and I'm proud to this day that my colleagues and I survived. There were also a lot of technique classes to learn how to move the bones around. Those were the fun classes! When you have as many as 33 hours in one semester, and you survive, it is quite an accomplishment.
While we were exposed to so much evidence-based, science in our school, we were also exposed to a lot of things that science has yet to back up. Things like the idea that a patient needs to be seen by a chiropractor once a week or once every other week for the rest of their lives. The idea being that everything running your entire body comes from the spine and that if you keep everything straight and the holes open that the nerves run through, then a person will never get sick, will never require vaccination and will function at the peak of their abilities. Just by having the spine adjusted. No other intervention.
These are the ideas the profession was founded on back in the late 1800s and the ideas that continue to permeate the profession to a much lesser extent in 2021.
To be fair, doctors of osteopathy now do surgery and enjoy equal footing with their medical doctor colleagues. But their founder, way back in 1874, believed that all elements of a person’s body, mind and spirit had to be incorporated into the total care of that person. He believed that the body had self-regulatory and self-healing powers, that the body contained within it all the substances necessary for maintaining health. When the body was properly stimulated, he believed that these substances would also assist in recovering from illness. You may have heard that those in the medical field once believed in blood-letting, leeches, and lobotomies.
Healthcare is steeped in science and it is my belief it should be led by science. The treatments and the thinking should be continually updated and upgraded as the science progresses and as the science demands. For the most part, that is exactly what we see happen with healthcare disciplines. Take the creation of the mRNA COVID vaccine in 2020. That is a feat that would have been unthinkable 15 years ago. Probably even 5 years ago.
There is no argument that the late 1800s had a good amount of over-reaching generalizations, philosophy, and vitalism as they looked for bigger and better ways to treat illness. Unfortunately, I have seen several times over the years in online chats, comments, or articles where chiropractic detractors have attempted to delegitimize the chiropractic profession by attacking its origins all the while completely forgetting the origination and history of their own favorite disciplines. That is the very definition of bias. We all had a starting point.
Getting back to chiropractic specifically, as a result of exposing future chiropractors to more vitalistic ideas like this in a collegiate setting, many different 'styles' of chiropractors were produced over the years. For simplicity purposes, I have tried to boil them down into three 'camps' if you will. My goal is not intraprofessional-bashing here so will try to curb any criticism as I describe them further. I want to be honest in my own perception. My goal, as I have said, is to educate the layperson on the varied flavors of chiropractors.
They are as follows:
- Evidence-based, Patient-centered
Let's discuss each of them briefly.
Evidence-based, Patient-centered Chiropractors
As full disclosure and in an effort to be transparent about my biases, this is the type of chiropractor that I am. An evidence-based, patient-centered chiropractor searches out the latest research. They pay attention to the newest recommendations and treatment guidelines that pertain to their profession. They allow their thinking and their treatment approaches to be guided and altered by the latest research and the latest information. They look for the best of the research according to the research pyramid. For example, case studies and pilot studies do not mean nearly as much as randomized controlled trials, systematic reviews, and meta-analyses.
Patient-centered means that the practitioner would NEVER perform treatment that likely would not help the patient just so they can make more money for the clinic. When practitioners bill things in the best interest of the clinic and the clinic's financial numbers rather than in the best interest of the patient, then that is not patient-centered. That is called 'doctor centered. While it seems silly to have to make this distinction, through all healthcare disciplines, this is a fact of life. Doctors of all stripes are found doing things that are financially motivated rather than in the best interest of the patient.
When we put the patient and their needs first we will almost always make the right decisions. I do this by asking myself, "If this patient were actually my family member, how would I advise them?" This has been my guiding principle my whole career and has yet to let me down.
This group of chiropractors got out of school, started a practice, and they are just surviving and doing their very best from day to day. They want to do a good job and they typically do. While they try to keep an eye on new and emerging research and information, they are not necessarily guided by it and not always that interested in furthering their learning or education through the years of their professional development. They graduated, they started a business, they are taking care of patients and making a living. It's that simple. They do the minimum to meet the requirements to maintain their license but not much more.
They do not necessarily buy into all of the more philosophy-based parts of the profession but also have not bought into the evidence-based side completely either. They are essentially agnostic and exist somewhere in the middle ground.
This group of chiropractors takes the founding principles of the profession from the late 1800s and holds tightly to them. As research furthers our understanding of neuromusculoskeletal pain and treatment, philosophy-based chiropractors tend to follow the notion that adjusting the spine regularly is all a patient needs to stay completely healthy. This type of practitioner commonly makes claims to fix just about anything and everything through adjusting the spine. Everything from ear infections and asthma to cancer and colic. They commonly advise patients against vaccinations because they claim that if you're adjusted regularly, your body will fight off measles, smallpox, polio, tuberculosis, and COVID.
While they may offer up some favorable case studies, there is no high-level research that I am aware of supporting these ideas in any meaningful way.
To dive a little deeper on the thought of consistent adjustment throughout one's life, I would offer the idea that being adjusted too often over a long period of time may actually be detrimental and can lead a patient into long-term pain. Let me explain. When I was a kid, I started popping my own neck after I went to a chiropractor for the first time. I thought it was cool and it felt good. It started out as being difficult to accomplish. Then it got really easy to do. In fact, it started popping on its own without me even actively trying to do it. Is that good or is that bad?
Self-adjustors pop their own neck often enough they eventually destabilize that area of the spine. They loosen the connective tissue and the tiny little muscles that hold everything so tight. That is why it gets easier and easier to pop the area the more it is done.
You should understand why a spinal surgeon fuses areas together. They do that because there is too much movement between the joints of the spine and that movement causes constant irritation. Basically, the looser your spinal joints become, the more movement in your spine, which means more consistent irritation and potentially pain.
So it makes sense that continually having adjustments weekly or biweekly for life would eventually lead to increased movement. As you have likely guessed by now, that would lead to some amount of instability and ongoing pain.
While there are different kinds of philosophy-based chiropractors, some focus on the sore spots only without much regard to the deeper, more concerning issues that could be going on with a patient. Only focusing on certain spots in the spine could lead to missing some really important stuff.
For example, I saw a post from a philosophy-based chiropractor a month or so ago on Facebook. In the post, the chiropractor was bragging about seeing 99 patients and 9 new patients within 3 hours. All by himself. Not only was he bragging about this foolishness but was also offering to teach others how to do the same thing.
I covered this extensively in my weekly evidence-based chiropractic podcast called Chiropractic Forward but will cover it briefly here as well. Basically, I spent time crunching the numbers. If each of the 99 established patients took an average of one minute to treat from the start to finish of each patient encounter (which is still substandard care by the way), then that leaves 81 minutes to examine and evaluate the 9 new patients. That means, per new patient, he has roughly 10-15 minutes for each new patient. In all reality, he probably had much less than that but let us assume the best-case scenario for this particular situation.
That's 15 minutes at best to do a lot of stuff. Things like,
- Review the history taken by the staff before he came in
- Review the range of motion if taken in advance by the staff
- Review the vitals
- Meet the patient and listen to their story
- Assess gait
- Assess standing posture
- Check yellow flags and discuss any that are present with the patient
- Check for red flags – not everyone needs x-rays
- Check reflexes
- Check dermatomes
- Check muscle strength
- Check neurodynamic positions for radiculopathy
- Assess for Ehler-Danlos and hypermobility
- Check orthos
- Check neuro testing
- Check for extension/flexion bias positions in some cases
- Come up with an accurate diagnosis
- Educate the patient on their diagnosis
- If chronic pain is part of the case, he has to educate on CNS upregulation and the biopsychosocial aspect of pain which is at least a 5 minutes conversation.
- Teach proper movement and biomechanics to remove the daily pain triggers
- He has to answer questions the patient may have
For comparison purposes, my new patient process takes roughly an hour to an hour and a half. As you might imagine, 15 minutes (at best) to process a new patient just is not something I can support. In my opinion, it is not enough time and attention to do a good, professional, and responsible job.
As with everything else in healthcare and outside of healthcare, there will be the good and there will be the bad. I am happy to let you decide which this is for yourself.
That podcast episode can be found at this link should you have interest in listening to it:
Chiropractic Is A Profession
Getting back to the original title of this article, as with other professions in the healthcare field, chiropractic has also progressed for the most part. The profession has progressed from being only concerned with spinal adjustments in its origin to now having the ability to say that chiropractic is not a treatment modality as it once was. Now chiropractic is a PROFESSION with LOTS of treatment modalities that fall within its scope and boundaries. Treatments like:
- Spinal manipulative therapy (of course)
- Muscle work
- Proprioceptive training
- Low-level laser
- Non-surgical spinal decompression
- Sports prep and recovery
- Therapeutic modalities
- Instruction for biomechanics
- Instruction for ergonomics
- Balance work
- And much much more.
You can see the obvious progression from its beginnings to where chiropractic is today. Not only that but spinal manipulative therapy, exercise, muscle work, acupuncture, and low-level laser have all been recommended by the American College of Physicians as first-line therapies for back pain.
Just fifteen to twenty years ago, you would never have imagined that a medical entity enjoying the status that the American College of Physicians enjoys would dream of recommending spinal manipulative therapy as a first-line treatment for back pain. But once again, chiropractic is not what it used to be.
Chiropractic is a big profession with lots of tools in the toolbox and a high level of education that can be leveraged in the patient's best interest to get them better, faster, and back into their lives. That looks different for everyone. A high school athlete performing better may be the way that presents itself in that demographic. But getting back to your life may mean that a grandma is able to keep up with the grandkids a little better. Either way, the right kind of chiropractic doctors have the tools to help you make it happen.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.