Definition of Chiropractic

This article appeared in the Pivot Review some years back.  I offer it again because it got lost in the darkness of cyberspace and it is applicable to today. 

B.J. Palmer’s defintion of chiropractic reads: “Chiropractic is a philosphy, science and art of things natural; a system of adjusting the segments of the spinal column by hand only, for the correction of the cause of dis-ease.”  Stephenson says “The first definition is Dr. Palmer’s and is the best” (R.W. Stephenson’s Textbook, p.xiii, 1927).

     Yet the straight chiropractic movement has abandoned this definition because it has established that if you use an instrument to correct vertebral subluxation in order to allow the innate intelligence of the body to better express itself you are practicing a straight objective.
     The overriding idea of the development of straight chiropractic in the last 20 years has been to set chiropractic apart from every one of the so-called healing arts and particularly making a clear distinction between it and the practice of medicine.  Therefore, our thrust has been to look, act, and speak less and less like medicine and to try to develop our own unique terminology, objectives, and procedures.  It seems that if that is our desire then we must consider getting away from the use of x-ray, which is by and large accepted by the public to be a test of medicine.
     There is no doubt that at times the use of an x-ray is valuable to find contra-indications to adjusting in certain areas of the spine.  This brings up two points.  The first relates to doing medical procedures to rule out contraindications to chiropractic care.  I find it very difficult to judge the use of a procedure such as George’s Test as not being straight chiropractic and then saying that x-ray to rule out contraindication is acceptable.  In both cases indications of medical conditions are being looked for. In neither case is a diagnosis being made.  In both cases a medical tool (sphyg and x-ray) is being used.  There appears to be very little difference.  It seems that there are contraindications to adjusting in certain areas and in using certain techniques.  If that is the case, and x-ray is a valuable tool in making that determination, then perhaps a radiologist should be the one to make that determination. After all, any contraindication is a medical condition and a trained medical doctor who specializes in looking at x-rays is the ideal choice to make that determination.  There are many chiropractors who have been doing this for years (myself included).  It instills confidence in the patient because you are recognizing another’s expertise.  It helps to convince the medical community that we do not claim to be diagnosticians.  I believe it builds respect for our profession.  It also is safer.  You have the benefit of a medical doctor’s expertise if litigation should ever occur. The radiologist in my area is happy to take x-rays, evaluate the films, and send me the results in a written report. Years ago an M.D. would not accept a referral from a D.C., let alone take the views he wanted or send him a report.  But times have changed.

The most important use of x-ray by chiropractors from a purely chiropractic standpoint is as an analytical tool.  There is no doubt that it has been and is still used by many good straight chiropractors to help determine listings and misalignment.  But again I think that time has decreased its value to us.  When x-ray was first introduced in 1910 there was no instrumentation.  There was no muscle palpation or motion palpation.  Thermography did not exist.  We have made great strides in our methods of analysis.  I believe many of them are far superior to the use of x-ray.  I have to say, and I’m sure that this will not set well with many readers, that most of the techniques that use x-ray extensively as a method of analysis appear to be very mechanistic in nature. I am not an expert in technique (nor x-ray for that matter), but it seems that they are more concerned with making orthopedic type changes in the spine as an organ than in correcting vertebral subluxations.  We cannot “claim the spine,”  orthopedic medicine already has.  Vertebral subluxations are our domain and frankly we have no more scientific proof that they  cause structural distortions of the spine as an organ than we do that they cause heart disease.
    They may very well be the cause of both heart disease and spinal distortions, but that is not the thrust of straight chiropractic and those chiropractors who have a technique that attempts to treat heart disease or spinal distortions miss the straight chiropractic mark.  While on the subject of technique, it is important to comment on the relationship between x-ray and adjusting.  It appears that x-ray is often a cop-out for good technique.  We should be delivering safe, effective, low-force adjustments that set the subluxated vertebrae into motion so that the innate intelligence of the body can make the adjustment.  Too often we use too great a force.  X-ray often gives us the excuse for doing just that. Again, I believe there is an historical factor here.  Eighty years ago, chiropractic techniques were relatively crude compared to today.  We have many techniques because of our knowledge of body mechanics, laws of physics, and more effective methods of analysis.  They enable us to introduce minimal forces to correct subluxations.  In a sense, x-ray helps promote 1910 adjusting techniques.  On a trip to Japan years ago, to lecture to a group of professionals, I was impressed by the Japanese chiropractors’ effort toward specificity.  They are legally not allowed to use x-ray.  Consequently, they constantly strive to be more effective in their analysis and more specific in their adjusting.  Isn’t it strange that the one group of people most straight chiropractors do not ordinarily x-ray are the group of people who under most circumstances receive the gentlest, most specific adjustment?  That group is babies.  We should be advancing in our technique, especially in our ability to deliver a safe, gentle, effective adjustment.  I believe x-ray may be holding us back in that advance.
     The very nature of straight chiropractic also creates a difference in the technique that was used in 1910.  In those days, the chiropractor knew he had only a few visits to “get the patient well.”  People did not have the inclination, nor the idea of lifetime maintenance care.  If the chiropractor did not cure them in one or two visits, his chances were over.  Consequently, he had to make drastic changes immediately, necessitating tremendous “racking” of the spine. If I am going to be checking and adjusting a patient’s spine every week for the rest of his/her life, it is not necessary that I “rack” every bone back into place on the first visit. I can gently get the feel of the patient’s spine.  I would rather use too little force and fail to correct a vertebral subluxation on the first few visits than use too much force on those visits, cause an adverse reaction in the patient, and have them forever turned off to chiropractic.  In a recent analysis of my straight practice, 73% of the patients coming in the office indicated a desire for lifetime maintenance care, 21% of them having no symptoms or problems when they first came in the office.  The 1910 chiropractor saw only sick people, often very sick people.  His practice dictated extreme measures.
     There are a few other points to consider. Chiropractors have in the past used x-ray as a patient education/patient management tool.  There is no doubt that a patient is going to be impressed by seeing their own x-ray and have a tendency to stay longer as a patient (increase your PVA) if you have their x-ray.  Perhaps twenty years ago that was a valid argument.  However, today with the patient education tools available to chiropractors and the communication skills that can be mastered, x-ray as a patient education tool is no longer necessary and cannot in my mind be justified either in cost to the patient or the danger.  As a management tool, its value is minimal.  It may keep that patient for a few more visits but we should be thinking of keeping patients for a lifetime, rather than a few more visits.  People will not stay in your office for a lifetime because you took, explained and are holding onto their x-rays.  They will stay because they understand the lifetime benefits of staying subluxation-free.
     The final issue to be addressed is by far not the least important.  That is the danger of x-rays.  It’s ironic that the creed of doctors is supposed to be “First do no harm” yet the first thing many chiropractors do to a patient is bombard them with ionizing radiation.  It is clear that in 1910 chiropractors had no idea of the dangers of x-ray itself or the cumulative effects.  But then nobody knew of them.  I have patients in my office who were patients of Dr. M________ in Philadelphia years back.  This chiropractor adjusted his patients under fluoroscope!  He practiced chiropractic that way until his fingers fell off! (That’s a true story.  I heard it from at least a dozen actual patients.)  When I was a child, which was not that long ago, we had our feet fluoroscoped when buying new shoes.  We clearly had little idea of the dangers of x-ray.  The argument today is made that a chiropractic x-ray involves so little radiation.  But television emits a little, so do computer screens, and electric blankets, high tension wires, microwaves, radar, cell phones, and on and on.  We have no idea what the cumulative effects of all forms of radiation are to the human body.  It seems that we as chiropractors should be part of the solution rather than part of the problem.  The exposure is increasing year after year.  What will it be like twenty years from now?  And we even have chiropractors advocating the x-raying of infants and newborns!  If you stand objectively on the sideline you would have to wonder whether we are crazy as a profession.  I guess I could go on and on.  But the Pivot is merely designed to make chiropractors think and this article is already the longest to ever appear in print.  I am not suggesting every D.C. should get rid of his x-ray unit tomorrow.  I am sure a good deal of good has come from chiropractors having taken x-rays in the past.  But we must begin to look toward the future for our profession.
     Straight chiropractic represents a maturity in chiropractic.  It represents a group of people who have outgrown the desire to be a part of the medical establishment by sneaking in the back door.  It is chiropractors who are above trying to mimic, compete or put down the practice of medicine.  We have advanced to the point of not feeling the need to be “all things to all people.”  We are secure in the service we offer and the benefit it provides.  We are the leading edge of chiropractic thinking.  Perhaps as such it is time we begin to reevaluate our attitude and our relationship to the use of x-ray.