- January 2001
Its
John’s Opinion
By John Gantner, DC
To those who aren‘t paying close attention it would appear that all that is necessary for the growth of every chiropractic practice is greater government recognition in Medicare and better state laws. If it were only so simple! While legislative accomplishments are important, even necessary, they remain, as always, the cart behind the horse.
Chiropractic’s real growth has come about since day one not from legislation but from superior clinical outcomes. Without this, there would never have been any reason for American citizens to press the state legislatures for licensure. And it was our consistent clinical results backed by a real service concept that caused these same citizens to turn to their legislatures once again to include chiropractic in workers’ compensation and other insurance programs. Later, in the 70's, in the face of an AMA orchestrated "White Paper" campaign against it, these same citizens prevailed upon Congress to include chiropractic services in Medicare. Somehow, those whom we entrust to lead our profession either refuse to recognize or simply fail to remember this critical fact.
The increasing literature supporting the value of spinal manipulation has caused a predictable result: strong interest by other branches of the healing arts, specifically the orthopedic community and physical therapists. They approach "spinal manipulation" as an extra modality that can be added to their historic clinical protocols. This guarantees that whatever spinal manipulation they do will be fairly basic when compared with those techniques available to the average chiropractor. They will do lumbar rolls and posterior dorsals and perhaps a few cervical rotaries or breaks. These, as we all know, represent fairly basic chiropractic adjusting procedures. And while these may sometimes be remarkably effective, they remain basic chiropractic techniques. Many of these basic chiropractic techniques are now taught in physical therapy schools. They are used generically, never with any thought of correcting a specific subluxation. They are applied primarily to decrease pain and increase ROM.
The question to us is simple: Is that what chiropractors do - decrease pain and increase ROM? To believe that is to have a shallow view of our work. Every chiropractor has been trained to adjust with the goal of improving health, not just treating symptoms. We are interested in reducing, and hopefully eliminating the subluxation(s) involved. We seek to establish a state where the clinical problem either never returns - or if it returns, it is less severe and goes away sooner. We seek to change the patient to a more healthy state, not simply to treat his/her symptoms. Physical therapists are now using basic chiropractic techniques. And they are successfully handling many of the easy cases - those that respond to simple techniques. Things like posterior dorsals, cervical breaks and the thoughtless variety of lumbar rolls - you know the ones you do on one side , then the other.
In view of these facts, it becomes clear that in some measure at least, the physical therapist is capable of doing the same thing a chiropractor does. In fact, some smart PR firms can make a case that because a physical therapist works with post stroke and post fracture cases, the physical therapist can do more than the DC. Where are the chiropractors in this picture?
So today, more than at any other time, it is essential that we offer a better service. In order to maintain and grow our market share we still need a chiropractic service that is superior to any spinal (extremity) manipulative service available elsewhere. Is there such a thing? Thankfully, yes. But the record shows that the better variety of chiropractic is practiced by a minority of chiropractors. That is because in order to learn the best chiropractic techniques a doctor must do so pretty much on his/her own - and at extra expense. This is because the best chiropractic techniques are not part of the core curriculum of our schools. In today’s health care market nothing less than clearly superior chiropractic service will cause any patient to opt out of restrictive HMO allowances or to quit seeing employer/carrier selected doctors. This underscores the need for a better chiropractic service. But instead of concentrating on the chiropractic clinical skills essential to developing a successful practice our schools tend to follow either of two courses: 1.) a primary concern with the basic sciences (which really isn’t worth too much when you are facing an antalgic patient with a hot Sciatica or a Thoracic Outlet Syndrome) or, 2.) remaining primarily concerned with the subluxation and with our "Principle" (which can be "adjusted" by any type of force at any point the doctor chooses. This is a veritable never-never land! Do whatever you want doctor, and if your intention is clear and you are "on purpose" the patient will get better.)
With respect, the chiropractic clinical work that the doctor does (and the quality of the clinical outcomes that got us here in the first place) is not given the priority it deserves in our schools. Every new doctor quickly discovers that compared to philosophy or basic science data, his/her ability to deliver a good chiropractic clinical outcome is of the greatest importance to his/her future. More than a few feel a clear inability to grasp and effectively manage the clinical situation.
In today’s competitive health care environment, the bottom line is still outcomes, not belief systems or personal preferences. If that is true - and I believe it is - then it is time that all chiropractors become aware of the wide array of excellent chiropractic analysis/adjusting/treatment techniques available today. Most chiropractic schools teach a "plain vanilla" technique that is generic and safe. It is also less effective. This puts new graduates at a clear disadvantage to their more experienced peers. History shows that by and large, our schools have stubbornly resisted the introduction of newer techniques unless discovered or invented by the school itself. Better techniques are available but are usually taught in hotel rooms by their discoverers. There are many reasons for this, running from strong egos and bigotry to simple ignorance. The best chiropractic techniques are not taught as part of the core curriculum in most of our schools. A few offer some elective courses in things like AK, CBP® or Activator. But because students must pay extra for it few take advantage of these electives.
They say that Major DeJarnette once told BJ Palmer to call him up when he wanted a better way to adjust an Atlas. He never got that call. Clarence Gonstead was a PCC alumnus with a history of having one of the largest and most successful practices in America for over thirty years. He was an old man before he was invited to the Palmer campus to speak. Most pioneers in chiropractic technique have had to go it alone teaching their work on the road. People like Nimmo, Mears, DeJarnette, Goodheart, Cox, Fuhr and Harrison have all experienced this lack of acceptance by their peers in the chiropractic educational community. It continues to this day in spite of the real clinical value of their ideas and work. Given this, it is time for practicing chiropractors themselves to become thoroughly familiar with leading techniques in the profession, taught by certified instructors, not some doc who took a single class or was once adjusted by one of these individuals. With all due respect to those who teach technique in chiropractic schools - it is precisely the teaching of technique by those who are poorly or incompletely schooled in their subject that is responsible for the plain vanilla techniques that are taught today. It is time for those of us in the field to demand better.
Better techniques, like CBP®, are available but are not supported commensurate with their clinical contribution or literature base. Physical therapy schools teach the literature that supports what they do. Why don’t we? Our new grads should have a clear working familiarity with all well accepted techniques that offer reasonable literature support. Such chiropractic techniques should be added to the core curriculum and taught by the most competent instructors. Failing that, these too will be "discovered" by some PT and taught at their schools. Where does that leave us?
If you agree that superior clinical outcomes are essential to the success of every chiropractic practice it is time to speak up. Write to your college and state the issue. In today’s healthcare marketplace a better chiropractic technique - one clearly superior to that taught in any physical therapy school - is a basic requirement. Ask your Alma Mater to give this the attention it deserves. Judging from what we see here on the street, they still do not know how important it is.
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