The seventies and eighties brought huge changes to chiropractic. In the early years, chiropractic was founded around a paradigm of restoring normal spinal alignment (structure), thereby allowing the patient to return to a more optimum state of health (function). Many more traditional chiropractors continue to view patient care strictly within this "structural" paradigm. Consider this from the International Chiropractors Association: "Abnormalities and misalignments of the spine, defined as subluxation(s) in chiropractic science, can and do distort the normal function of the nervous system and may create serious negative health consequences."
In the late seventies, everything changed with the sweeping introduction of the "new paradigm" in chiropractic. Popularized largely by proponents of motion palpation methods, the new paradigm emphasized the importance of restoring normal spinal motion (function) as opposed to more traditional concepts of attempting to correct abnormal spinal structure (alignment). Many doctors were frustrated with the difficulties of actually changing spinal structure and studies were showing that traditional adjustments did very little to actually correct spinal misalignment. In short, the new paradigm found a very willing audience, particularly within many academic circles. With the introduction of the new paradigm, subluxation has come to be viewed almost exclusively as a problem of function (motion). For a sizeable portion of our profession, the importance of healthy spinal structure has become somewhat of a philosophical dinosaur consigned to the bone yard of philosophy.
For a while, it seemed so simple. No need to worry about pesky post care X-rays showing little or no correction; just make sure the joints felt mobile and everything would turn out fine. Of course, things weren’t that simple. They rarely are. Doctors in the field continued to see patients return with the same old symptoms. Misaligned spines continued to degenerate. Restoring joint mobility was one thing, but keeping the spine mobile and healthy was quite another.
Where the new paradigm fell short was in assuming that normal spinal motion is possible within the framework of sub normal spinal alignment. We now know this isn’t possible. In biomechanical systems such as the spine, motion is certainly a very important measure of function, but it definitely doesn’t stand alone. As it turns out, the intricate coupling patterns of vertebral motion are inseparably linked to the overall architecture of the spinal column. Structure and function, it seems, are just two sides of the same coin.
Consider the two postures in Fig.1 and Fig.2. The patient in Fig. 1 demonstrates a fairly normal posture with the head well centered over the shoulders. The patient in Fig.2 demonstrates forward head posture due to loss of the cervical lordosis. It would be illogical to think the hypolordotic neck would exhibit the same quality of intersegmental motion as the normal neck. Likewise, it is obvious that these two spines will have very different loading factors on the joints’ surfaces. Surrounding musculature is forced to work differently as the origins and insertions change orientation respective to each other. There is a great deal of research to now indicate that healthy structure (posture) is essential for a number of reasons and that structure is intimately wedded to function.
So why start a column about postural rehab with a discussion of two wildly differing paradigms? Simple…. Chiropractic’s "Dueling Paradigms" are at the heart of many of the issues which continue to divide us professionally. Perpetuation of this false dichotomy fosters intraprofessional tension and weakens us politically and financially. Both approaches have value to the clinician and rigid adherence to either paradigm drastically limits your ability to understand and help complex cases. Trying to separate structure and function is totally unnecessary and scientifically unsound. In many cases, it creates a type of professional tunnel vision which can unintentionally shortchange our patients as we seek the cause of their health issues. It is vital that we look at patients from both sides of the equation.
We know a lot more about correcting posture than we did thirty years ago. Today’s doctor has a number of tools available to help achieve real, measurable corrections which simply weren’t possible when our profession first embraced the "new paradigm." I think you’ll find that incorporating postural rehab will bring with it a number of benefits, regardless of your present mode of practice. Most of the treatment and analytical methods we’ll be covering are easily grasped without the need for extensive training, will cost little or nothing to implement, and can be readily applied by doctors of all techniques. From a more practical perspective, you’ll find the straightforward concepts of postural rehab to be very understandable for your patients. For well over a hundred years, chiropractic patients have intuitively grasped the connection between spinal structure and health.
In subsequent issues, I’ll try to share concepts from both paradigms to help you achieve the best corrections of your career. Best of all, I get a chance to show you some of the methods by which doctors of all techniques can easily start to apply proven methods of postural analysis and rehab without investing a fortune in dollars or time. Hopefully, some of the tools and methods we’ll cover in future issues will help make real and substantial structural corrections a practical reality in your practice.
Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To download a full and unabridged version of this article, link to www.MatlinMfg.com or call 1-334-448-1210.