What are we trying to accomplish in straight chiropractic, besides the actual correction of the subluxation? We are developing in the patient a knowledge of the importance of a systematic approach to the correction of vertebral subluxation and the continued monitoring and subsequent adjusting for the rest of their lives when necessary. We call it “patient education.” It is done so the human organism can express a little more of what it was intended to be. We are not presenting chiropractic as a drugless aspirin. We are not presenting the subluxation correction as a quick fix to an individual’s ailments, acute or chronic. Because of this approach, we do not have to worry about correcting every vertebral subluxation on the first visit. What we are doing when a new patient walks into our office is developing an EASE restoration and maintenance program that will take place over a lifetime. It does not have to be done in one visit, one week, or one month. In fact, it cannot be. It is very much analagous to an exercise program. Some people develop a crash exercise program to lose 30 pounds in four weeks. They usually abuse their body, perhaps doing more harm than good. They are often unsuccessful and if they get the desired results, those results usually do not last. Other people, perhaps with the same weight problem, will develop an exercise program with the idea that it is for health – for life. Their program may be less strenous and will show less dramatic results. But it will be more enjoyable and the ultimate results will be greater, spread out over a lifetime. Straight chiropractic care is analagous to the latter approach. It is not necessary for us to worry about correcting every vertebral subluxation every time in certain situations or under certain circumstances. We can feel comfortable in modifying our “program” so as to avoid areas of pain, unstable areas of the spine, places where trauma and medically diagnosed disease are said to be present. After all, if you view that patient as a regular lifetime patient, there is no need for the “crash program” type practice. The chiropractors who have “crash program patients” know that they need to get results in a short time. As much as they tell themselves they are not treating that bad back and even as much as they tell the patient they are not treating their bad back, they know that they had better get results in a certain amount of time. The “crash program D.C.” is the one who tends toward neurological orthopedic tests. He feels he must correct that vertebral subluxation in 5L or the patient will not get better and will not come back and can never be “converted” into a lifetime patient. Hence he must do neuro- logical orthopedic tests to determine whether it is safe to thrust into the 5L area. The point is that you are going to lose patients no matter what you do. No chiropractor has ever kept for lifetime care every patient who walked into his/her office. Now, you can lose them for the right reason or lose them for the wrong reason. You can lose them because they wanted “crash program chiropractic” and you do not provide that by 1) using questionable medical procedures (modalities) to make them feel better or 2) using questionable medical procedures (neurological orthopedic tests) to determine whether it is safe to administer adjustments into questionable areas of the spine. You simply say, “Sorry, we do not provide that type of care.” Still don’t get it? I can tell by the wrinkled brows some of you do not! Let’s go back to our exercise analogy. Let’s say you are running a “straight” exercise health club. You accept clients for a lifetime exercise program. Your program is based upon the person’s coming in regularly for the rest of his/her life. That’s your system. One day this 47 year old guy with a beer belly walks in and says “I want to lose this gut in 90 days. Just give me exercises to lose it, I don’t care about my cardiovascular system or strengthening my spinal muscles or anything else. I just want to lose this gut.” What do you say? If you are truly straight you say “well, that’s not how our program works. We are going to set you up on a regular program of exercise, which, in fact, will not even concentrate on your waistline for the first ninety days. But here’s what this program will do for you!” Do you lose him? Maybe you do, maybe you do not. But if you believe in the principle of your exercise program, you stick to it. If you don’t, you put him on a waist reduction program and ignore what might be more important aspects of his health care relative to exercise.
Practicing straight chiropractic is easy. The hard things is being faithful to and living by the principles that cause you to practice straight. It’s just a matter of deciding whether you want a “crash program” type of practice or a straight one. I believe there is a place for both types of chiropractic practices and some chiropractors may derive a certain degree of satisfaction and enjoyment out of practicing the former. But they are the ones who have never tried the latter. Once you try a straight lifetime patient practice you will not want to go back and you definitely will not want to mix the two!
Now for the practical application. If we are checking and adjusting people for vertebral subluxations for lifetime regular care, perhaps we need to worry less about adjusting vertebral subluxations in areas of the spine where there is the slightest contraindication to introducing a force into the area. It’s funny how history goes in cycles. B.J. began the HIO technique because he did not want chiropractors promiscuously thrusting into “dangerous areas.” He wanted to minimize the number of forces introduced. Perhaps we need to move back in that direction. I’m not saying we should all practice HIO. But isn’t it interesting that the Specific Upper Cervical practitioner who accepts a patient with extreme low back pain never has to worry about doing neurological orthopedic tests, or an x-ray or an MRI to see whether it is safe to thrust into the lumbar region. He just analyzes the area of the spine he is going to adjust, explains to the patient what he is doing and why he is doing it. He goes ahead, does his job and it works. Perhaps if we full spine practitioners had more of that mindset, we would be less worried about doing injury to areas of the spine with the symptoms of medical problems because we would avoid those areas. We would not feel the need to resort to medical procedures to see if it is safe to adjust there. We just would not adjust there. Perhaps we should have this rule: If you feel you need to do an neurological orthopedic tests or other medical procedure to determine whether it is safe to adjust in an area then it’s not. some further thoughts on this subject . . .
Neurological Orthopedic Tests – Part II
In The Pivot Review, Volume 2, Number 2, there was an essay on Neurological Orthopedic Tests being performed by chiropractors. The article basically addressed the fallacy of straights using the tests to determine the absence or presence of vertebral subluxation. There is now, however, a new approach by some D.C.s. They are using them to determine the safety of chiropractic care. The chiro- practor will claim he/she is not making a diagnosis, but merely determining through these tests whether it is safe to introduce an adjusting thrust. The argument is used that a straight will use a case history and x-ray to determine safety of adjusting in a certain area of the spine, why not N.O.T.s? There are numerous arguments against straight chiropractors using N.O.T.s to determine the safety of an adjustment. Obviously, mixers should use them, for they are determining whether to treat a patient for a specific disease or condition and must know what that condition is. Perhaps something should be stated right now, lest any chiropractor misunderstand the straight chiropractic position. It is the position of the Federation of Straight Chiropractic Organizations in their Chiropractic Standard of Care/Patient Safety that: “clinical responsibilities are . . . C. to determine the propriety of chiropractic procedures” (Chiropractic Philosophy, 208). This determination is a necessary part of the practice of straight chiropractic care.
With that said, let us look at the arguments against using N.O.T.s from a philosophical, practical and legal standpoint. First, philosophically it is unsound. Chiropractic is not medicine. It has a different objective, different terminology, and different procedures. Medicine is locating and treating the presence of something (disease), chiropractic is restoring something that is absent (ease). If chiropractic is to maintain the uniqueness its philosophy dictates, it must endeavor to look less and less like medicine, not more and more.
But most of those advocating the use of N.O.T.s are not concerned with philosophy, so let us look at the practical reasons. The first reason is that N.O.T.s do not tell you whether to adjust an area or not. Every chiropractor who has been in practice for some time or seen a number of patients has had numerous cases to prove this. A patient will come into the office saying he/she has been medically diagnosed as having a herniated disc, and told that surgery is needed. The chiropractor, based upon his evaluation and whatever criteria he uses, determines that it is safe to introduce a force into that area of the spine. He does so and ten years later the patient is still under care, still apparently healthy and still without the spinal surgery. Maybe the D.C. was lucky, maybe he was foolish, or both, but the point is that a patient who has positive responses to N.O.T.s is not necessarily ruled out as being able to receive a chiropractic adjustment, even in the involved areas. Thousands of chiropractors are knowingly adjusting in areas where people have disc problems, osteoporosis, and vascular deficiencies and are not causing any problems. Thousands of chiropractors, mixers and straights alike, are unknowingly doing the same thing and are not causing any problems. In fact, when it comes right down to it, a chiropractor’s causing a problem by his/her adjusting is so rare and unusual that it does not even seem worth the discussion. It seems that some of the straights have bought the mixer lie that our non-diagnostic care is going to injure people. Yet, history and malpractice statistics would argue that it is not even a problem. Those few cases that do occur can easily be prevented by a little common sense, improved adjusting techniques, and procedures that are not inconsistent with our philosophy. N.O.T.s are not a logical approach for chiropractors, simply because they are not accurate for chiropractic care. They were designed to determine the presence or absence of a medical entity, not presence or absence of a vertebral subluxation. They were intended to give medical information, not to tell the chiropractor whether it is safe to adjust in a particular area. You cannot use anything for a purpose other than what it was intended for and expect it to do an adequate job. Razor blades are for shaving, not for sharpening pencils. Automobiles are for driving on roads, not plowing fields, and N.O.T.s are not intended for determining the safety of chiropractic care. They are simply inadequate for the task. Let’s find something that is adequate, and is consistent with our philosophy rather than falling back on procedures which are questionably adequate for the purpose in which they were intended (medical) and in no way adequate for our purposes.
The last area to evaluate is the legal one. Obviously all these areas are interrelated. That which is philosophically sound is also logical and presents the legally safest approach. N.O.T.s are a screening process used by physicians to diagnose and determine the appropriate treatment. If a chiropractor does these tests, and his records indicate it, he is professing to have a level of expertise which he will be judged by. N.O.T.s are merely one of the first steps to determining a diagnosis. If you perform these steps and do not follow through with the subsequent procedures such as CAT Scan or MRI you could be judged to have deviated from the accepted standard of care. What I’m saying is that you cannot pick and choose which aspects of medical procedure you want to do. If you start down the medical road you better be prepared to go all the way. A well-known malpractice case took place in New York some years back where the D.C. did certain diagnostic tests and then claimed he did not diagnose and he hence was not responsible for a condition that the M.D. expert witness said any third year medical student would have determined. The jury ruled against the chiropractor, and the judgment was in excess of three million dollars!
It is clear we in chiropractic must have standards of care and procedures to de- termine patient safety. But adopting medical procedures is not the answer. v8n2