Passing Over a Fertile Niche
Dear Editor:
It seems as if the chiropractic profession continues to engage itself in the same endless wars. This time chiropractors are at war with the PTs. Actually, they're at war with the PTs again. Apparently chiropractors believe they own manipulation, and consider manipulation of any articulation by anyone other than a chiropractor to be an invasion of the chiropractic profession's soul. Imagine a health care profession building an empire on one and only one modality. Exclusive of acupuncture, I cannot think of any other profession that is solely dependent on one modality.
The sad part is that any attempt by chiropractors to protect joint manipulation and/or joint adjustment is futile. This is a no-win war for chiropractors. Sure, the Wild West DCs may win the battle [read "Wild West: DCs Take on PTs," April 15 issue], but the issue remains illusive. The PTs have defended their position by using semantics. As your article clearly stated, "they believed their laws prohibiting practicing chiropractic and a chiropractic adjustment did not mean a Grade 5 mobilization." Mobilization is not manipulation! They win. Period.
Unfortunately, chiropractors believe that distinguishing between manipulation and mobilization will put this issue to rest. We've been there before. Why should the issue be different now? It hasn't resolved anything in the past. Exclusive of acupuncture, I cannot think of any other profession that defines itself by the type of treatment it provides. We have locked ourselves into the manipulation paradigm.
I've been in private practice for more than 33 years. During this period, the vast majority of my patients sought my care because they thought I was a specialist for their back and/or neck pain. They did not consult me because they wanted manipulation. In fact, a considerable percentage of patients were not good candidates for manipulation, didn't want manipulation or didn't respond well to manipulation. Despite these facts, the collective minds of the profession hold strong to defining themselves as manipulative / adjustment specialists.
If chiropractors had a clear and credible scope of practice, these issues wouldn't be ongoing. I believe chiropractors need to fulfill the public mandate or continue to struggle for survival. That mandate is clear: a spine specialist that can provide whatever modalities are necessary, including the use of pharmaceuticals. There are no medical specialties that offer comprehensive care for spinal disorders. Yet chiropractors continue to pass over this fertile niche.
Robert Falco, DC
Weehawken, N.J.
I Treat Segmental Dysfunction
Dear Editor:
In response to the letter from Dr. Kotheimer, "Debunking Key Myths," in the March 1, 2013 issue, I agree with most of his "myths." However, myth #2 is not as simple as he puts it. First, let's look at just what is going on in a "chiropractic subluxation." There is a restriction of normal motion, either partially or completely. This restriction is mainly due to muscle tension and most times due to involuntary muscles. This complex ("VSC," as some have put it) is what irritates the nervous system, causing compensatory reactions by the body and a Domino effect resulting in pain, etc. Talented adjusting releases this complex and the resulting reactions to function more normally, reducing pain and improving overall function of the body.
If we reference B.J.'s writing on primaries and secondaries, our goal is to treat the primaries and the secondaries will not be needed by the body. (However, sometimes they become a problem themselves and become primaries.) I don't have a problem with his "concept of the (chiropractic) subluxation." The problem occurs with the term when dealing with the scientific and medical communities.
Subluxation in their world is a "partial dislocation" and a far cry from what we are referring to. A segmental dysfunction is a far superior and more accurate term to describe the "chiropractic subluxation."
If we want to be recognized as scientific and accurate to be accepted into mainstream medicine, we need to be accurate in our terms. The concept of a "chiropractic subluxation" is not outmoded; but the term is! There is no "sense of fear," as Dr. Kotheimer puts it.
There is a desire to be accurate. I know chiropractic works and works very well. But I don't treat subluxations; I treat segmental dysfunctions.
Edwin Travis, DC
Bastrop, Texas
Dynamic Chiropractic encourages letters to the editor to discuss issues relevant to the profession and/or to respond to a previously published article. Submission is acknowledgment that your letter may be published in a future issue of the publication. Submit your letter to editorial@mpamedia.com; include your full name, relevant degree(s) obtained, as well as the city and state in which you practice.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
