April 2002

It's Jason's Opinion

A CALL TO ACTION: Use Your Voice or Lose Your Freedom

by Jason Haas, DC

A very disturbing trend is occurring within chiropractic, a trend that seems to have its roots in the creation of the CCE accreditation group for chiropractic schools in conjunction with the ACA and the ACA diplomate programs, such as the one for chiropractic radiology (DACBRs). This trend is undermining the very principles that the founders of chiropractic had hoped to create by spreading chiropractic to the world. This trend is the removal of the word subluxation from the vocabulary of chiropractors, the denial of the use of radiographs for diagnosis of subluxation, and the increased move toward pain-centered manipulation only.

            More and more, groups of chiropractors who either don’t know that subluxation exists because of an ignorance of the current scientific literature1 or, because they have been brainwashed by educators who wish to propagate their own philosophies, have removed subluxation from their vocabulary and have given credence to notions that chiropractic care is necessary only for low back pain, neck pain, and headaches; that x-rays are only necessary in “red-flag” cases only, and that the use of x-rays for biomechanical abnormalities constitutes grounds for reprimand from state boards. This has carried over to the insurance companies who, at the recommendation of IME’s, DACBR’s, DACBO’s, and ACA representatives have cut the claims of chiropractors who utilize the current scientific literature and correct the structural abnormalities found in their patients. Unfortunately, many chiropractors only see their patients for 8-14 visits because this is the usual time necessary to get a person out of the pain that they are experiencing.

            We can thank the ACA and the Mercy Center Guidelines for this 8-14 visit number. Although in a letter to Dr. Harrison from ACA’s president, Dr. Daryl Willis, dated 3-08-2002, Dr. Willis claimed that the ACA was not solely responsible for the Mercy Center Guidelines. He lists several organizations as sponsors including ICA. To which, I respond that ICA came on board to give a minority opinion and was out voted (34 to 1??). We all know that ACA and its members originated the Mercy Center Guidelines’ Committee and stacked the deck with IMEs (in an article in this journal several years ago, Dr. Dan Murphy suggested that 29 out of 35 Mercy Committee members were IMEs). Our Chiropractic market share has drastically reduced since insurance companies and IMEs began in 1992 to use these “ACA” guidelines, which Dr. Willis claims that ACA was not primarily responsible for. So Dr. Willis are you now claiming that the idea of these guidelines and the Mercy Center Committee were not originated within ACA? If the ACA was not responsible for these guidelines, who was?? ICA?? World Chiropractic Alliance??

            The ACA has another dilemma - subluxation. On the one hand, in Medicare, the original terminology was “subluxation as determined on x-ray” and recently ACA used “subluxation” and correction thereof as what makes DCs special and unique in their legal brief to HHS. On the other hand, several “ACA” college presidents and “ACA” college faculty members claim that there is no such thing as subluxation (reference- email messages, RAC Conferences, JMPT published articles). They prefer “FSL” (Functional Spinal Lesion), whatever that is. Also DACBRs have been teaching that one cannot measure a subluxation on radiographs. I suggest that if the ACA is serious in saving the word subluxation, as used in their legal briefs to the US Government, that they straighten out their political and academic leaders who claim otherwise publicly.

            Many chiropractors are taught by their instructors at chiropractic colleges or seminars that the procedures they use on their patients are “adjustments”, which would imply a change toward normal. These procedures are in fact, manipulations used by a variety of professions. These manipulative procedures are highly effective in pain control but have been shown to have little effect on the resting position of the spine (recall Subluxation is bone out of place causing nerve interference). Because of this, some chiropractors do not believe that changes are possible because they do not see changes in a large percentage of their patients’ spines, if any. This has led them to not question DACBR’s, or others who claim that whatever spinal position the patient has must be normal, as long as there is no pain. Chiropractors who are not involved in the political branches of their own profession are allowing DACBR’s, DACBO’s, and others to dictate how they can treat their patients, when many of these individuals, making legislative decisions, may not even practice.

            There is, however, a growing group of chiropractors that utilized CBP® principles to correct abnormal spinal structure to affect function. The application of these CBP® principles is based on time-dependant biomechanical changes to the disc, ligaments, muscles, bones, and nervous systems of their patients.6-10 Various rehabilitative procedures are used to align the individual’s frame from skull to thorax, thorax to pelvis, and pelvis to feet.6 See Fig. 1. In addition, certain curvatures are necessary for normal function of tissues. CBP® Traction protocols are outlined to correct abnormal sagittal configurations. This care takes time. Unfortunately, chiropractors who are not familiar with these corrective techniques either don’t believe they are necessary or, worse yet, possible. CBP®

 has now published four clinical controlled trials, which show the efficacy of the protocols used.2-5 But for some reason, some of the most powerful (politically) chiropractors don’t read the current literature and continue to profess that chiropractic is best utilized for pain only.

             This must stop. As a young chiropractor, the future, in which I have to constantly fight to give my patients the corrective care they deserve, is a nightmare. The only way that we can change the wrongful belief that chiropractic is for pain only is through action. Chiropractors who continue the propagation of false beliefs must be thrown from their positions of power by the voice of the next generation of chiropractors. Many chiropractors in the 1980’s destroyed insurance privileges for the new generation by abuse and criminal fraud. The same is happening when the ignorant old guard of chiropractic propagates the idea that chiropractors cannot, or should not, correct spines. To the youth of today, I say, “Stand up and fight for your rights.” Use your voice in political bodies to educate the ignorant and create a fair playing field for the good of yourself and your patients. Do research to validate the existence of subluxation and the necessity for the correction of abnormal spinal configurations. In other words, get involved in your profession or lose your freedom to practice as you choose. There is a saying that the only constant is change, chiropractic too must change and dispel the outdated, ignorant falsehoods that continue to keep this great profession down. To the old guard who wishes to keep chiropractors in the pockets of the insurance companies who will only pay for 12-14 visits, cut claims, and deny radiography, I say get on the train or get out of our way. And to the chiropractic colleges and the presidents of those colleges, I say shame on you, your core curriculums do not reflect the current state of literature by including CBP® and you are harming all of us when you claim, in your mission statements, that you wish to provide the best education for future chiropractors and yet purposely withhold the most researched chiropractic technique in the world. The politics of the old may be crushed while truth and honesty in chiropractic must prevail.

References

1.         Harrison DE, Harrison DD, Troyanovich SJ, Harmon S. Its Time to Accept the Evidence for a Normal Spinal Position. J Manipulative Physiol Ther 2000; 23: 623-644.

2.         Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. New 3-Point Bending Traction Method of Restoring Cervical Lordosis Combined with Cervical  Manipulation: Non-randomized Clinical Control Trial. Archives Phys Med Rehabil 2002; in press.

3.         Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction: Non-randomized Clinical Control Trial. Archives Phys Med Rehabil 2002; In press.

4.         Harrison DE, Harrison DD, Betz J, Janik TJ, Holland B, Colloca C. Increasing the Cervical Lordosis with CBP® Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Non-randomized Clinical Control Trial. J Manipulative Physiol Ther 2002; in review.

5.         Harrison DD, Jackson BL, Troyanovich SJ, Robertson GA, DeGeorge D, Barker WF. The Efficacy of Cervical Extension-Compression Traction Combined with Diversified Manipulation and Drop Table Adjustments in the Rehabilitation of Cervical Lordosis. J Manipulative Physiol Ther 1994;17(7):454-464.

6.         Troyanovich SJ, Harrison DE, Harrison DD. Review of the Scientific Literature Relevant to Structural Rehabilitation of the Spine and Posture: Rationale for Treatment Beyond the Resolution of Symptoms. J Manipulative Physiol Ther 1998;21(1):37-50.

7.         Harrison DD, Troyanovich SJ, Harrison DE, Janik TJ, Murphy DJ. A Normal Sagittal Spinal Configuration: A Desirable Clinical Outcome. J Manipulative Physiol Ther 1996;19(6):398-405.

8.         Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART I: Spinal Canal Deformations Due to Changes in Posture. J Manipulative Physiol Ther 1999; 22(4):227-234.

9.         Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART II: Strains in the Spinal Cord from Postural Loads. J Manipulative Physiol Ther 1999; 22(5):322-332.

10.       Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART III: Spinal Cord Stresses from Postural Loads and Their Neurologic Effects. J Manipulative Physiol Ther 1999; 22(6):399-410.