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How to Explain “SICKNESS” to Your Patients
Perspective
Written by Ogi Ressel, DC   
Thursday, 25 July 2013 18:32
L
et’s cover an issue that many doctors often struggle with handling. You are doing your chiropractic “thing” and a patient suddenly says, “Dr. Bob, I couldn’t see you last week because I had the flu. I thought that if I was routinely adjusted, I wouldn’t get sick anymore.”
 
childSo how do you react? Do you panic or feel anxious? I am sure most of you have experienced this question in one form or another—and it made you suddenly feel a little uneasy. This is when you, a well-adjusted doctor with a university degree and tons of experience who has studied the art and science of chiropractic, start to babble defensively. Have I missed anything?
 
We all tell our patients that chiropractic will keep them well—that is the chiropractic wellness paradigm. Our care is hinged on the fact that what we will provide our patients with amazing health, and that’s the truth. 
 
However, sometimes the body has other ideas, and patients need to understand this. Let me explain with an example. When a child gets the flu, he or she experiences a runny nose, coughing, fever, swollen and glassy eyes, loss of appetite, lethargy, weakness, etc. Parents have been conditioned to believe that this means their child is really sick.
 
Yes! This is sickness at its best. But you need to look at this from a very different perspective: all of those symptoms have an amazing reason for being. They are not random. The nose runs to excrete the virus, for instance. The child may have diarrhea to excrete the bug further. Fever is the result of extra work produced by the body as defense mechanisms are brought in to fight the invading organism. The lacrimal glands produce continuous tears to cool down the cornea so its heat-sensitive protein makeup is not damaged, which is why the child looks glassy-eyed. There is no appetite because the body shuts down digestive cycles and shunts all energy to defense. 
 
All these activities are designed for one purpose only, and that is to restore health and remove the invading organism. That puts this whole “sickness thing” in a very different light. It means that all these things are not random symptoms that need to be treated.  
 
It does not mean that the child is sick. No, it means that the body is doing exactly what it was designed and programmed to do. This is not an example of “sickness.” This is an example of health! It is what should happen! Granted, it may not be pleasant—your child may not like it, but it is an expression of health.
 
So, when confronted with questions about “sickness,” remind your patients that there is an innate intelligence ruling their bodies. Ultimately, that innate force knows what is best for that body at that time. It also knows that all body systems need to be exercised regularly in order to function at optimum levels at all times—that is the expectation, isn’t it? Just like any other part of the body, the immune system also needs to be exercised. 
 
I personally feel we have a built-in “clock” which activates the immune system, temporarily lowers our immune guard and response, and we are then attacked by a bug of some sort. The response is a sudden activation of the immune system to fight off the invading organism. But what your patients need to understand is that this is not sickness. This is an expression of health—the body doing exactly what it is programmed to do. This is a good thing! 
 
Next time a patient gets “sick,” then you need to say, “Wonderful!”
 
At first the patient may look at you as if you’ve just lost all your marbles, but once you explain this process, he or she will understand what you mean and think that you are amazing—and you are! Your patient just needs to understand that having the occasional flu is a very important part of keeping healthy and that the body will not be at its best without it. 
 
So, relax and tell your patients the truth—they will totally get it! 

Dr. Ogi is a Practice Coach and teaches the Practice Evolution Program. He is an international lecturer, a pediatric and x-ray specialist, researcher and clinician. It was Dr. Ogi and Dr. Larry Webster who started the whole pediatric awareness and movement on the planet - when it comes to kids, he has no equal. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or www.practiceevolution.com
 
 
Organized Medicine Considers Chiropractic as a "First Line" Solution to the Opioid Epidemic
Perspective
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Thursday, 25 April 2013 20:08
T
he opioid problem in the United States is real and the prime culprit is prescription opioid pain relievers. Paulozzi, Jones, Mack, and Rudd, in The Centers for Disease Control and Prevention's (CDC) publication, Morbidity and Mortality Weekly Report, on November 4, 2011, state: "In 2007, nearly 100 persons per day died of drug overdoses in the United States. The death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in 1991. Prescription drugs have accounted for most of the increase in those death rates since 1999. In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse or abuse of pharmaceuticals, compared with 1.0 million ED visits related to use of illicit drugs such as heroin and cocaine. Prominent among these prescription drug-related deaths and ED visits are opioid pain relievers (OPR), also known as narcotic or opioid analgesics, a class of drugs that includes oxycodone, methadone, and hydrocodone, among others. OPR now account for more overdose deaths than heroin and cocaine combined."
 
opioidepidemicPaulozzi et al. (2011) continued, “In 2008, drug overdoses in the United States caused 36,450 deaths. OPR were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Death rates varied fivefold by state. States with lower death rates had lower rates of nonmedical use of OPR and OPR sales. During 1999-2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially . . . . The epidemic of overdoses of OPR has continued to worsen. Wide variation among states in the nonmedical use of OPR and overdose rates cannot be explained by underlying demographic differences in state populations but is related to wide variations in OPR prescribing . . . Health-care providers should only use OPRs in carefully screened and monitored patients when non-OPR treatments are insufficient to manage pain. Insurers and prescription drug monitoring programs can identify and take action to reduce both inappropriate and illegal prescribing. Third-party payers can limit reimbursement in ways that reduce inappropriate prescribing, discourage efforts to obtain OPR from multiple health-care providers, and improve clinical care. Changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription drug abuse and overdoses while still allowing safe and effective pain treatment." Organized medicine is now taking a hard look at this "epidemic type" issue and has reached to chiropractic for possible solutions.
 
In 2012, Dr. William Owens, a chiropractor from Buffalo, New York, was conferred as an adjunct associate clinical professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Family Medical Practice. After working for five years to position himself within the institution, Dr. Owens began teaching the application of chiropractic (via chiropractic referrals) through clinical rotations to family medical residents as well as lecturing to the entire medical school body. As a result, he has been invited to participate in the research department to consider a formal study showing the benefits of family practitioners co-managing cases with chiropractors. Although much of the education surrounds chronic conditions and how chiropractic offers treatment options for acute and chronic musculoskeletal conditions and mobility issues as solutions for cardiac and diabetes, the primary reason for introducing chiropractic to these students is to offer chiropractic care as an acceptable and proven "first-line" choice of referral and possible solution to the opioid epidemic.
 
Cifuentes, Willets, and Wasiak (2011) reported in the Journal of Occupational and Environmental Medicine: "In work-related LBP [nonspecific low back pain], the use of health maintenance care provided by physical therapists or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment" (p. 396). They went on to report, "In general . . . those cases treated by chiropractors consistently tended to have a lower proportion in each of the categories for severity proxy compared to the other groups; fewer used opiates and had surgery. In addition, people who were mostly treated by chiropractor had, on average, less expensive medical services and shorter initial periods of disability than cases treated by other providers" (Cifuentes et al., 2011, p. 396).
 

The outcomes showed that when chiropractic care was pursued, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs, was reduced by 37%.

DeBar et al. (2011) reported that, ". . . recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain — despite their high costs, potential adverse effects, and modest efficacy — suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM [complementary and alternative]treatments for CMP [chronic musculoskeletal pain], which are often well accepted by patients and increasingly used in the community" (p. 1). DeBar et al. rate chiropractic as one of the most promising, with the highest acceptance by physician groups and the best evidence to support its use.
 
A study by Legorreta (2004) compared more than 1.7 million insured patients looking for treatment for back pain. The outcomes showed that when chiropractic care was pursued, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs, was reduced by 37%. Furthermore, 95% of the patients that received chiropractic care said they were satisfied with their treatment.
 
These types of studies have given medicine the insight to teach medical school students and family practice residents that chiropractic should be considered as a first-line alternative to opioid utilization. Dr. Owens has also been invited to be part of the process determining how state and federal grant money for research should be utilized in trying to find a solution for opioid issue with chiropractic as a primary solution. He has been able to create a partnership between  the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Family Medical Practice and the University of Bridgeport College of Chiropractic in a joint research project around chiropractic utilization and opioid utilization.
 
While many groups and organizations within chiropractic are seeking scope changes to include limited prescriptive rights, it is because we offer a non-drug alternative that we are now considered as the solution to the problem that medicine created. In the past, this author looked at the numbers of possible chiropractors becoming primary care medical providers with the consideration that if we controlled the patients from the access point, we could get considerably more people under chiropractic care. However, with chiropractic being accepted and taught in medical schools as a solution, we now have a voice during the medical educational process and need to let medical doctors do what they are trained to do, albeit with one exception; chiropractic needs to be considered as the first-line referral for any spinal-related conditions and the effects thereof.
 

The question we need to ask as a profession is: are we to become part of the solution or part of the problem?

With chiropractic being the first-line referral, the doctor of chiropractic gets to educate and treat the patient in a non-drug environment while offering a real solution to both the opioid epidemic and the vast array of solutions to other issues that chiropractic offers. Now that a pilot program for chiropractic to teach medical students and family practice residents has been created and accepted within medical academia, other doctors of chiropractic are currently being trained to bring chiropractic to medical schools nationally. Over a relatively short amount of time, this program will be taught to the next generation of medical doctors and family practitioners, creating a significantly increased need for chiropractic nationally and a solution for the opioid epidemic.
 
With further research to bolster the studies already available, the concept of it being malpractice for a medical doctor to prescribe an opiate without first considering a course of chiropractic care is no longer deemed unattainable. If chiropractors are able to order prescriptive drugs, we may ultimately be prevented from inclusion in organized medicine's solution for the opioid epidemic because we will be part of the problem rather than being uniquely positioned as part of the solution. The question we need to ask as a profession is: are we to become part of the solution or part of the problem?
 
References:
  1. Paulozzi, L. J., Jones, C. M., Mack, K. A., & Rudd, R. A. (2011). Vital signs: Overdoses of prescription opioid pain relievers — United States — 1999-2008. Morbidity and Mortality Weekly Report (MMWR), 60(43). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm
  2. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404
  3. DeBar, L. L., Elder, C., Ritenbaugh, C., Aickin, M., Deyo, R., Meenan, R., Dickerson, J., Webster, J.A., & Yarborough, B.J. (2011). Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study. BMC Complementary & Alternative Medicine, 11(118), 1-18.
  4. Legorreta, A.P. (2004). Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine, 164(18), 1985-1992.
 
 
Why Don’t MDs Refer to Chiropractors?
Perspective
Written by Joel Starr, DC   
Thursday, 25 April 2013 19:57
T
he coveted physician-referred patient is a source of pride for those chiropractors fortunate enough to receive one. The referrals may come in large numbers, proliferate and, if done properly, be self-sustaining.
 
mdandchiroHowever, reaching out to local physicians is something the average chiropractor thinks little about or even attempts. Fear prevents many chiropractors from trying something new and different; we enjoy our practice comfort zones. This is a colossal practice mistake. We find contentment with our technique of choice and do not hesitate to ask a current patient for a referral of a friend or a family member. We do this for one primary reason: we simply must in order to survive in practice. Secondly, we become quite good at requesting patient referrals, and most chiropractors in this country thrive primarily on them.
 
I often ask other chiropractors around the country: "Why don't medical doctors refer patients to chiropractors?" There are several objections that at first seem reasonable but in reality could not be farther from the truth.
 
A common objection is that physicians "hate chiropractors." This simply is not true. They dislike any specialist who makes them feel uneasy or in the dark about their patient. In turn, any specialist who acts roguishly and unconventionally without first consulting with the MD will see a cessation of referrals. Physicians must be kept informed.
 
Another objection is that MDs question our being "real” doctors. We produce charts to tout all of the hours of anatomy and physiology that we attend to in chiropractic schools and how they compare to our MD colleagues. The problem is that we show these charts to our patients and not the MDs. How are they to know? Are we expecting our patients to make a case for us? The truth is MDs do not think we are uneducated. We are licensed doctors, and they know and respect our ability to treat patients. They simply do not know what we actually do. All of the degrees and titles we acquire will never earn us an MD's referral if we care for their patients in ways that they do not understand, or worse, that we fail to inform them about.
 
I have often heard that MDs will not refer to chiropractors because they think we will "cannibalize,” or steal, their patients from them. A primary care doctor may see over 100 different cases per week, or 400 per month. A conservative estimate is that 10% of those seen are musculoskeletal complaints, which is 40 patients. If the MD treats half of these patients, then there will be 20 patients that must be referred out for therapy. It is imperative that the MD not be worried that the specialist will cannibalize his patients. He sends to cardiologists, neurologists and endocrinologists on a daily basis. If he feels confident in what you do as a chiropractor, a musculoskeletal specialist, he will truly appreciate having an additional clinic to which he can send his patients. If chiropractic sees only 8-9% of the population, why would we not turn to where over 90% of the patients visit?

By nurturing your relationship with physicians today, you stand to enjoy a healthy supply of new patients for many years to come.

 
A physician's referral is extremely strong. These patients tend to be more compliant and are eager to begin care. Once MDs refer a patient to you and trust is developed, they will stand by you and support the care you provide. We had a patient with a rotator cuff injury present to our office. Kinesiotape was used as part of the treatment. The patient developed a rash from the tape and related this to his physician. The MD responded, "Don't worry, they are good, it will heal. Just keep up with the therapy." The patient returned to our office and related what the MD said in response to his now-healing reaction to the sports taping. The patient said, "Gosh, my doctor said you guys are the best and not to worry. He wasn't concerned at all!" Clearly the MD thought our education and experience was enough to handle this incident. If we gain the trust of the MD, they will not be afraid that we will harm their patient, and furthermore, they will support us during those rare occasions we do.

The key to acquiring physician referrals is to build lasting, professional relationships. Just like any relationship we cherish in life, much care and attention must be given to our relationships with our local physicians. After all, we are all in it for the patient. View yourself as a fellow member of the healthcare team, and you will succeed. By nurturing your relationship with physicians today, you stand to enjoy a healthy supply of new patients for many years to come.

Dr. Joel Starr, D.C. is a co-director of a Multidiscipline clinic in Silver Spring Maryland.  He is also a consultant for Consultants of America and Endless MD Referrals.  For more information on medical doctor referrals, call (888) 972-0811.

 
New Software = New Improved Practice
Perspective
Written by Claude Cote   
Sunday, 24 February 2013 22:50
T
here are tons of reasons why chiropractors change the software in their office.  Most of the time, lack of service and software limitations trigger this important decision.  Often, the goal of changing chiropractic software is to eliminate a frustration over the software or the provider you deal with.  If you are thinking about changing your software for whatever reason, why don't you use this opportunity to make an overall upgrade of your practice? In plain English, this means that while changing your management software you can make some very signifiant improvments to the efficiency and profitability of your office.  Here are only a few examples of what you can do.
 
Automate your waiting room
softwarenewAutomating your waiting room is the best-kept secret of chiropractic.  Doctors who do this automation are never going back to the old system.  Simply explained, let's imagine your CA is sick today and cannot work at the front desk.  All patients have a Chiropractic Health Card and swipe in at an electronic sign-in device on their arrival at the clinic.  While being in the treatment room, the doctor activates the calling feature. Then, the magic goes on. The system will call the next patient and direct him to the next available treatment room.  Don't worry, you will not hear a digital voice.  The doctor or the CA records every new patient's name and the system will use these recordings to play in the speakers.  Every time a patient leaves a room after his treatment, the system will call the next one.  This will release your CA from overseeing this aspect of management and will give her plenty of free time to do much more profitable tasks.
 
Use Xray, thermo scan, posture image, etc. every visit
Many software programs have an imaging module to store and retrieve all images you may need to improve your patient's care.  While adjusting your patient, you may press a key and instantly get all his x-rays, compare them, etc. If posture is important for you, you will see how your patient stands and how good or bad his posture is.  All images assisting your treatment will be available at your fingertips.
 
Activate automatic billing
While entering your SOAP notes, your new software will automatically post all the charges to the patient's file.  Not only will the charges be posted but all transactions will be formatted and ready to be submitted to the insurance carriers. This will be done live, and you will not have to rely on any CA or other billing person to trigger all the charges.  The billing will always be accurate and maximized. Automatic billing from the treatment room is mistake-free and saves a lot of time for your staff.
 
Use an outside billing service
Using an outside billing service can be a tremendous help to your office.  Good insurance billing employees are hard to find and can be expensive.  You also have to pay for benefits, vacation and many other expenses.   Additionally, you need to evaluate your own time needed to manage these employees.  The chance is very high that you will save a lot of money by getting a professional and hassle-free billing system.  If you ever plan to use an outside billing service, then the choice of new management software becomes crucial.  Some of them are designed to be used by these external services, but others simply are not.  The best of the two worlds is to have your software company do your billing service as well.  This means one call can solve it all.
 
There are many other aspects of your practice you may improve.  Automation means improvement.  Changing software is definitely the right thing to think about and make it happen. Those improvements may go way beyond the software itself.  When shopping for new software, please ask questions about how it can help you improve your office.  You may be very surprised, as software providers may suggest things you have never thought of.
 
Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 18 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com).  For comments or questions, please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
The Driving Force of Function: A Tonal Chiropractic Proposal
Perspective
Written by Fred Clary, DC, DIBCN   
Monday, 21 January 2013 02:03
F
or years chiropractors have stated collectively that structure equals function. The structure of the spinal column gives the chiropractor a standard by which to establish clinical guidelines for therapy. This presumes that there is a structural component to the spine that is perfectly adapted for the individual patient’s immediate and long-term needs that can be imposed by outside standards. Current chiropractic theories state that small asymmetries are pathological and ineffective and that they cause disease and decrease normal physiology of humans. These negative traits of small rotary asymmetries in the vertebrae, the classic chiropractic subluxation, would naturally decrease evolutionary fitness. But to state this is also to affirm that the small rotary asymmetries at the local level in the spine were not adapted for and selected against. These theories presuppose that the spine, after 400 million years of development, has not selected for species fitness and success as a biological line. How could these small asymmetries exist for 400 million years if they did not increase fitness?
 
drivingforceoffunctionBasic evolutionary fitness is the probability that the line of descent from an individual with a specific trait will not eventually die out. Perhaps those small rotations may be small adaptations to the many degrees of freedom, cultivated over 300,000 generations of vertebrate existence, allowed by the hominid spine. These small asymmetries may be pathological in the short term or long term, or these small asymmetries may be the best physiological adaptation for the individual to preserve resources in the short or long term.  Perhaps these asymmetries may contain both traits.
 
An understanding of proper function and the analysis of patients with small rotary asymmetries in the spine reveal that many of these patients have lived to a ripe old age and reproduced effectively. If this is documented fact, it leads one to deduce that small rotary asymmetries are at least not fatal to those individuals. To state that small asymmetries are always pathological would deny the fitness of 6.2 million years of human bipedalism, natural selection and generational adaptation. If these slight rotations were always a source of inefficiency and decreased evolutionary fitness, then the rotations would have been deselected for, and they would not have survived to the present.

The original chiropractic theory of vertebral subluxation (functional anomalies) is incomplete and is as follows: The exertion of pressure on a spinal nerve produces pathology by interfering with the planned expression of Innate Intelligence. This statement is incomplete when we recognize that the vertebral column has been evolving for over 400 million years of vertebrate evolution to support the body and protect the central nervous system (CNS) in many millions of vertebrate species.
 
Traditional chiropractic—segmental and postural-technique classifications—evaluates abnormal function as a result of labeled abnormal structures. These labels are self-developed and described in isolation in the chiropractor’s practice or technique. Tonal chiropractic, a subset of chiropractic technique and theory, has attempted to respond to these inconsistencies by looking at the input side of structure. The abnormal structure can lead to abnormal function that continuously feeds the CNS with aberrant input. Or, the aberrant structure is the individual’s best attempt to adapt and save resources given the current immediate demands of the internal and external environment. Tonal chiropractic techniques explain that symptoms that we see in our clinics are a result of neuron-physiological partitioning. Since the CNS controls and regulates all physiological processes of the human body, optimizations must first occur at the microscopic cellular level in the nervous system. All of the changes can be explained by considering the process of energy efficiency of neural communication and neural processing. Energy, which is available ATP, is finite. It is reasonable to assume that the limiting factor for this energy resource/metabolic-efficiency-optimization process is the use of available ATP. Thus, to optimize neurological programs, the CNS will shunt and mobilize ATP to the areas of greatest physiological need in the CNS. Tonal chiropractic relies on observable biological standards.
 
History has proven, especially recently, that our scientific understanding of certain human physiological traits is not only incomplete but also at times plain wrong. The recent revolutions in the areas of CNS—neuroplasticity, the existence of widespread adult CNS stem cells and the “discovery” of the bidirectional communication of the CNS and the immune system—are areas of science that have changed 180 degrees from their original dogmas. This limitation of human understanding proves our generation’s descriptive limitation and the evaluation of normative function. But proper physiological function must be historical if human existence is a product of 400 million years of vertebrate adaptation and positive modifications.
 
Ruth Garrett Millikan, born in 1933, is a well-known American philosopher of biology, psychology and language, and she described the term “proper function” in the late 1980s.  Proper functions are the sorts of functions that biologists assign to the organs of animals and are the sorts of functions that human organs have. In the context of the philosophy of biology, the notion is introduced that proper functions are what things are for, whilst other functions of the design are not. Thus, it is possible to distinguish having the function X from merely functioning as X. Both of these linguistic distinctions can be used to mark a rough boundary for the term “proper functions.”
 
Function is any activity that can be produced by a structural entity. Proper functions differ from other functions in that they can explain the reason for a structure’s existence. The presence of the heart, for example, can be partially explained by its capacity to circulate blood and move oxygen into tissues. These functions provide an evolutionary and natural-selection explanation of the presence of the heart. But the presence of the heart cannot be explained by its ability to cause severe pain during a myocardial infarction event. The ability to cause pain is a function of the heart but is not its proper function; causing pain is pathological, but it does not lead to greater evolutionary fitness. The normative, or fitness, function could be said to be the heart’s proper function, but it would not be evaluative because, of course, normative definitions change with better understanding of biological functions. By definition, proper function is defined historically over evolution. For example, science used to understand that CNS glia cells were simple supportive structures; we now know that glia cells are the most important cells in the CNS for intercellular communication and neuroplasticity. Some glia cells are not supportive at all but are, in fact, adult stem cells. The proper functions of a trait are those with ancestral evolutionary fitness components. These functions of a trait are advantageous and are those selected over time. The effect is a positive adaptation. To explain a trait by alluding to its proper function is to explain it as the result of natural selection in the way with which we are all familiar.
 

In other words, how can we have patients who have these asymmetries and who are athletic superstars with large, socially stable families?

When addressing the functions of the spine, one must specifically separate and define the proper functions and “foundational” functions. Proper spinal functions are functions that can best fit their place in the evolutionary fitness picture. The foundational functions of the spine must first fit in the overriding natural selection process. Function X or Y as described as a spinal function must first agree with evolutionary biology. If spinal function X or Y, though desirable, denies the natural selection process and evolutionary biology for all vertebrates, then the description of the observation must be incomplete.    The incomplete description of spinal function X or Y cannot be a proper function. Furthermore, if the function of the spine is to maintain perfect alignment with complete axial symmetry, but this “model spine” cannot be found in living or deceased humans—or in any vertebrates for that matter—and, moreover, perfect symmetry may not have evolutionary value, then perfect axial symmetry may not be a normative, or foundational function. 
 
There can be no statistical outliers to foundational function. If a few specimens with small rotary asymmetries are observable examples of maximum human performance and presumed evolutionary fitness—biological and athletic rock stars—then the principle of traditional chiropractic that small asymmetries lead to depressed function is visibly incomplete. Although perfect axial symmetry may exist theoretically as a spinal function, it does not supersede evolutionary drive and proper foundational function. The proper structure of the spine, as described by traditional chiropractic paradigms and colleges, cannot override examples of super normative function and faultless evolutionary fitness. If small rotary vertebral asymmetries have a deleterious effect on individual function and fitness, how can an individual have these asymmetries and have perfect adaptation traits and outstanding biological function? In other words, how can we have patients who have these asymmetries and who are athletic superstars with large, socially stable families?
 
So what is the proper function of the spinal column? Perhaps it is protection of the CNS and spinal cord, intersegmental flexibility that allows for great range of movement and mobility. Greater mobility adds to species fitness, or evolutionary survival ability. But again there must be an underlying principle that is true in every case when applied to all spinal functions. These functions of the spine are not the foundation function, which is, of course, evolutionary fitness. The first and primary proper function of any biological structure is energy efficiency. The proper functions must first and foremost satisfy the evolutionary fitness requirement before another function can be assessed.
  
Does your chiropractic technique evaluate in real time the patient’s proper physiological function that would increase evolutionary drive? High-priority physiological functions like breathing and circulation should be evaluated pre- and post-chiropractic intervention.  Can chiropractic or allopathic intervention be positive for the individual if it does not increase real physiological function despite its nociceptive effect? Increasing the body’s main physiological traits, e.g., breathing, circulation and heat regulation, should be our prime motivation for intervention. The body, after 6.2 million years of walking upright, will shift resources to maintain basic abilities. If we assist the body in prime physiological functions, the body’s innate ability developed over 400 million years will utilize the freed-up resources to improve fitness and heal local injuries and disease.
 
This brief article is designed to begin conversations within the chiropractic community as to what is the best physiological function to analyze in order to guide our adjusting techniques. Is it okay to have a chiropractic intervention (or an allopathic one, for sake of conversation) that may decrease pain but maintains or assists in degraded physiological function? Do we assess global physiological functions that biology and science have always proven affect every cell, such as breathing and circulation, or do we assess physiological functions on a small local level, such as segmental biomechanical function, muscle spasms and swelling, and presume they have global effects? The patient’s leg length may be even, but does that correspond to an immediate positive change in prime physiological functions like breathing, circulation, heat regulation, nutrient absorption,  CNS informational processing, energy efficiency or overall health? Is L5 right-rotated a pathological structural malposition, or is it the best adaptation that 400 million years of winning can produce to maintain efficiency and drive towards fuller expansion of our human potential? Do we evaluate physiological and pathological asymmetries? Is it always best to adjust that swollen, painful high spot, or is there a bigger game we should consider? Do we really trust that after 400 million years, the human body knows how to adapt efficiently in the short term? Or for those of other religious flavors, do we think we are divine junk?
 
Chiropractic is at a crossroads. For decades we have maintained that there is a perfect structure and that perfect structure leads to the best function. But that optimal structure has traditionally been a static definition, ignoring the basic principles of evolution through natural selection and energy-efficient adaptation. We have forced curves and aligned vertebrae when those apparent pathologies may be the best physiological choice at the time. It can be said that at the moment of birth, the nervous system begins to adapt to the gravity environment utilizing the structures available to it. Those structures are changed and modified over time as the efficient function drives the dynamic structures. Can chiropractic evolve at these crossroads to address those patients we have yet to reach out to? We should be reaching out to patients in wheelchairs or who are post-stroke or who have cerebral palsy, where perfect structure can never be attained. Do we pull our collective heads out of regional curves and aligned pedicles and embrace functional markers as the only objective finding that correlates to health? When the patient’s function outweighs the clinician’s biases, then chiropractic will have evolved to truly remove the interference, or inefficiency, from the patient’s nervous system. Using functional objective markers like breathing regulation, cardiovascular status, proprioceptive acuity and/or gait efficiency will dramatically change one’s practice and the clinical results.
 
Selected References:
  • Andre Ariew (Editor) (2002). Functions: New Essays in the Philosophy of Psychology and Biology
  • Bowler, Peter J. (2003). Evolution: The History of an Idea. University of California Press. ISBN 0-52023693-9.
  • Clary, Frederick. (2006). Functional Analysis Seminar Manual
  • Futuyma, Douglas J. (2005). Evolution. Sunderland, Massachusetts: Sinauer Associates, Inc. ISBN 0-87893-187-2.
  • David H. Peterson (Author), Thomas F. Bergmann (Author) (2002). Chiropractic Technique
Dr. Fred Clary, D.C., D.I.B.C.N. is the creator of the chiropractic technique, Functional Analysis. This technique focuses on detecting and correcting breathing inefficiencies as well as improving movement and gait patterns. He teaches the Clinical Neurology Diplomate for NWHSU. Dr. Clary holds world records in powerlifting. Contact him at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it  or call  at 612-865-8430.
 
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