Editor's note: With so much reaction to Dr. Seaman's recent two-part series on the "curse of chiropractic," in the way of letters to the editor (see the Oct. 26 issue) and personal correspondence, he authored the following article as a way of further exposition.
My previous two articles on the "curse of chiropractic"1,2 have generated interesting comments and debate, and illustrate the confusion that still exists within our profession regarding science, philosophy and subluxation. I received many criticisms, some stating that I misinterpreted Stephenson's description of subluxation, others defending the existence of subluxation because they somehow thought that I said subluxation did not exist. Readers should be aware that I merely quoted the curse of chiropractic according to Stephenson; I said nothing about the nonexistence of subluxation.
However, it does seem that one of our major professional problems revolves around how certain DCs view subluxation. The problem seems to rest largely with the leaders of straight chiropractic who believe and promote the notion that mental impulses from innate intelligence are blocked in the IVF due to spinal subluxation.3 In fact, many of the criticisms I received came from DCs who support this absolutely erroneous notion.
Readers need to realize it is Stephenson who describes this view of subluxation as the "curse of chiropractic."4 He states the following:
"Nerve cells are tissue cells having a body, nucleus, protoplasm, etc., as any other tissue cell. They are living organisms having adaptability; requiring mental impulses and nutrition as any other cell. The writer [Stephenson describes himself as the writer] is emphasizing these points, for it is the curse of Chiropractic, one of the things that corrupt the science, that students of Chiropractic will persistently forget that the nerve cell is a living thing, very sensitive and delicate, and mental impulses are immaterial messages and not a material something which can be dammed back in the nerve by an interference, as by the gate. The nerve cells function is to convey mental forces by the 'wriggling' of its protoplasm. It 'wriggles' or 'squirms' obediently at Innate's bidding, responding to its Adaptability (see signs of Life) and by its behavior, informs Tissue Cell what Innate's demands are."
As stated above, Stephenson indicates that the curse of chiropractic functions to corrupt the science of chiropractic. First, we should consider why Stephenson would make such an issue of the curse and then describe it as the corruptor of the science of chiropractic. In other words, the subluxation curse is not compatible with subluxation science, and this is according to Stephenson; I am merely quoting him.
Although it's denied by many DCs, such as Koch5 and Strauss,6 it's a fact that Universal Intelligence is synonymous with God, and Innate Intelligence is synonymous with the human soul or spirit. I recently co-wrote a review article that provided detailed citations attesting to this fact.7 Stephenson also verifies this on several pages (p.xvi,17-20); and Senzon's review of the spiritual writings of B.J. Palmer provide additional substantive evidence.8 So, to state that Universal and Innate Intelligence are blocked by subluxation is to state that God or Spirit is blocked by subluxation.
In the many religious texts I have read from the world's most popular religions, I have never encountered a description of the omniscient, omnipresent Lord wherein he is described to be so weak as to get stuck in the IVF or anywhere else. My suspicion is that Stephenson realized the preposterous nature of this notion that God is blocked in the IVF, and so he described it as the curse of chiropractic.
Science and Philosophy vs. the Curse
Regretfully, many DCs think there is a war or debate within chiropractic between science and philosophy; however, such a war is absolutely impossible. As it relates to the health care profession, philosophy is not about belief or faith in the unknown. Philosophy is defined as the "the critical study of the basic principles of and concepts of a particular branch of knowledge, especially with a view to improving or reconstituting them,"9 and the word philosophy literally translates as the love of wisdom.10 It's impossible for the pursuit of knowledge and the love of wisdom to be at odds with science. The goal of philosophy and science are the same. So, in fact, philosophy and science have a common enemy; and that enemy is dogma.11 Similarly, the philosophy and science of chiropractic are at war against the curse of chiropractic.
Science of Chiropractic in 1927
Some 80 years ago, we really had no science. There were no studies on adjustment mechanisms and there were no clinical trials. Eighty years ago, we had the subluxation theory of IVF encroachment. Stephenson described it as a (M) misaligned vertebra that lead to the (O) occlusion of the IVF, which placed (P) pressure on spinal nerves and caused nerve (I) interference (p.2). Stephenson necessarily emphasized that the curse of chiropractic was at odds with the IVF encroachment model of subluxation (p.275). For many in 1927, IVF encroachment represented the science of chiropractic.
Thus, according to Stephenson in 1927, we should drop the curse of chiropractic because it corrupts the science. Stephenson also was obviously urging his contemporaries to embrace the science of chiropractic, which, applied to subluxation, was represented at that time as the IVF encroachment model. Naturally, Stephenson's IVF encroachment model of 1927 is not set in stone, so long as we apply the principles of philosophy/science. According to the mandates of philosophy/science, we constantly must evaluate our principles and theories to ensure they are reasonable and consistent with reality; and it turns out the IVF encroachment model is sorely lacking in substance.
Science of Chiropractic After 1927
Since 1927, as the activity of philosophy/science was applied to spinal function, for the purpose of advancing our knowledge, we discovered that nerve compression, i.e., the IVF encroachment theory of subluxation, is an uncommon clinical entity. Chiropractic and medical authorities have made this abundantly clear. Leach12 states: "Although it is a definite possibility that nerve root compression or irritation may be caused by intervertebral subluxation subluxations, especially in the cervical or lumbar spine, it has not been proven that this relationship is a common clinical occurrence."
Waddell indicates that less than 5 percent of subjects suffering from low back pain have nerve root compression.13 And it's likely that many of these individuals are suffering from an inflammatory response within the nerve root, not mechanical compression.14 Bogduk is more vivid in his description, stating that unless accompanied by signs of compression (loss of dermatome sensation, reduced muscle stretch reflexes, and muscle weakness) it's likely not nerve compression that is the cause of any pain.15 Even when signs of nerve root compression are present, it does not necessarily indicate that nerve roots are compressed. For example, pain, positive SLR, reflex changes and muscle weakness also can be due to internal disc disruption without nerve root compression.16
Additionally, Henderson's chapter in Foundations of Chiropractic: Subluxation describes the seminal paper from 1976 on the facet syndrome by Mooney and Robertson.17 Part of their study involved subjects with back pain, a positive straight leg raise (SLR), and reduced muscle stretch reflexes (signs of nerve root compression). Subjects were treated with a facet joint injection of lidocaine, and this led to a reduction in pain and normalization of the SLR and reflexes. The authors concluded that based on such findings, "we no longer consider diminished straight leg raising or reflex changes to necessarily implicate nerve root pressure by disc protrusion."
B.J. Palmer once stated that "when facts are known, knowledge exists; when we possess knowledge, faiths and beliefs disappear." We need to heed Palmer's words and drop the notion that we commonly treat IVF encroachment. Today, only those who are possessed by the curse of chiropractic seem to believe in the outdated and inaccurate IVF encroachment model of subluxation.3 This is unfortunate, as our knowledge of spinal dysfunction and the neurobiological effects of spinal adjusting are far advanced beyond Stephenson's simplistic model.
And what of Dr. Suh's research from the University of Colorado? He and Henry West, DC, published a three-part review in the ACA's journal in 1974.18-20 On page one of part one, they state that compression on the sciatic nerve with as little as 10 mmHg causes a 40 percent reduction in nerve transmission. Supporters of the curse of chiropractic seem to think this single paragraph is all they need to make foolish claims about nerve interference caused by IVF encroachment. Read these articles for yourself and you will see that not a single clinical example of such nerve compression was provided; the IVF was never discussed - and to this day, there has never been a study to demonstrate that such interference occurs in humans due to IVF encroachment.
In fact, it's well-known that mechanical compression will cause conduction block. Peripheral nerves easily are isolated in animals and artificial mechanical compression is applied in a way that does not happen in humans, which means Suh's statement cannot be applied to spinal subluxation models. This becomes especially evident when we consider that pain and visceral symptoms are the conditions we see in practice, and such symptoms occur due to increased nervous system activity,32-33 not a 10 percent, 40 percent, or even 90 percent reduction in the nervous system information that is flowing out of the IVF. Additionally, the three papers by Suh and West actually outlined research plans that Suh was supposed to pursue, but never did. The "curse" continues to be at odds with the science of chiropractic.
In 2006, we know a great deal more about spinal function and dysfunction compared to 1927. And yet, for some odd reason, the curse of chiropractic continues to gain new followers. Students have told me they have interviewed with practitioners who explain that "chiropractors are instruments of God," in the sense that the DC does the adjusting and God does the healing. Students also are told that the foramen magnum is the "Mouth of God" and that adjusting frees up the interference. Why some students and doctors buy into this nonsense is not at all clear. Perhaps they are confused, and/or have a superficial background when it comes to religious/spiritual concepts. Nonetheless, this mindless embracement of dogma is occurring at a time when we have more science/philosophy of chiropractic than at any other time in history; and at a time when major science publishers are happy to print chiropractic textbooks. I can only wonder how it's possible to embrace the curse when we have the following:
- texts by Leach12 and Gatterman21 that provide a thorough review of subluxation theories and clinical chiropractic issues (back pain, headaches, non-pain symptoms, etc.);
- research published in the 1980s and 1990s demonstrating spinal adjustments improve movement asymmetries;22-26
- research demonstrating that adjustments cause lumbar facet joint gapping,27 which confirmed the 1970 theory of Sandoz;
- research demonstrating hyperexcitability muscle activity is reduced after spinal adjustments;28-29
- research demonstrating cervicogenic vertigo is reduced after spinal adjustments;30
- research demonstrating that hearing can improve after spinal adjustments;31
- review articles scientifically outlining how visceral symptoms can be generated by spinal dysfunction.32-33
The above is only an introduction to the basic science research on adjusting and case histories involving positive outcomes after chiropractic interventions. So, with all of this in mind, it does seem unbelievable that in 2006, we would continue to have students and DCs who remain possessed by the curse of chiropractic. They are loud and boisterous in their advancement of the curse, and in so doing they obscure and continue to corrupt the science of chiropractic; thus, they impede our profession's growth.
- Seaman DR. Subluxation issues: the "curse of chiropractic" according to R.W. Stephenson. Dynamic Chiropractic, Sept. 1, 2006. www.chiroweb.com/archives/24/18/16.html
- Seaman DR. Subluxation issues: the genesis of the "curse of chiropractic." Dynamic Chiropractic, Sept. 14, 2006. www.chiroweb.com/archives/24/19/19.html.
- Practice Guidelines for Straight Chiropractic. Chandler AZ: WCA; 1993, p. 29.
- Stephenson RW. Chiropractic Text Book. Davenport: PSC; 1927: p.275.
- Koch D. Has vitalism been a help or a hindrance to the science and art of chiropractic? J Chiro Human 1996; 6(1):18-25.
- Strauss JB. Chiropractic philosophy. Levittown (PA): FACE; 1991: p.44.
- Seaman DR, Luce A. The contrasting meanings of innate intelligence and their practical utility. J Vert Sublux Res, April 9, 2005:1-4.
- Senzon SA. The Spiritual Writings of BJ Palmer. The Second Chiropractor, Vol 1. Privately published by Simon Senzon DC, Asheville, NC, 2004.
- The Random House Dictionary of the English Language. 2nd ed, unabridged. New York: Random House, 1987: p.1455.
- Webster N. American Dictionary of the English Language. New York, NY: S. Converse, 1828.
- Seaman DR. Philosophy and science versus dogmatism in the practice of chiropractic. J Chiro Humanities 1998; 8:55-66.
- Leach RA. The Chiropractic Theories. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004: p.265.
- Waddell G. Back Pain Revolution. 2nd ed. New York: Churchill Livingstone; 2004: p. 11.
- Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum. 4th ed. New York: Churchill Livingstone; 2005: p.185-186.
- Bogduk N. "Innervation, Pain Patterns, and Mechanisms of Pain Production." In: Twomey LT, Taylor JR. Eds. Physical Therapy of Low Back Pain. New York: Churchill Livingstone; 1994: p.93-109
- Giles LGF. 50 Challenging Spinal Pain Syndrome Cases. New York: Butterworth Heinemann (Elsevier); 2003: p. 62-68 (case 11).
- Henderson CN. "Three Neurophysiologic Theories on the Chiropractic Subluxation." In: Gatterman MI. Ed. Foundations of Chiropractic: Subluxation. 2nd ed. New York: Elsevier; 2005: p.296-304.
- Suh CH, West HG. Biomechanics of the spine. Part 1. ACA Journal of Chiropractic, 1974; Vol VIII (June): S82-S91.
- Suh CH, West HG. Biomechanics of the spine. Part 1. ACA Journal of Chiropractic, 1974; Vol VIII (July): S97-S104.
- Suh CH, West HG. Biomechanics of the spine. Part 1. ACA Journal of Chiropractic. 1974; Vol VIII (August): S113-S123.
- Gatterman MI. Ed. Foundations of Chiropractic: Subluxation. 2nd ed. New York: Elsevier; 2005.
- Carrick FR. Cervical radiculopathy: the diagnosis and treatment of pathomechanics in the cervical spine. J Manipulative Physiol Ther, 1983;6:129-37.
- Nansel DD, Cremeta E, Carlson J, Szlazak M. Time course considerations for the effects of unilateral lower cervical adjustments with respect to the amelioration of cervical lateral-flexion passive end-range asymmetry. J Manipulative Physiol Ther, 1990;13:297-304.
- Nansel D, Jansen R, Cremata E, Dhami MS, Holley D. Effects of cervical adjustments on lateral-flexion passive end-range asymmetry and on blood pressure, heart rate and plasma catecholamine levels. J Manipulative Physiol Ther, 1991;14:450-6.
- Nansel DD. Peneff A, Quitoriano J. Effectiveness of upper versus lower cervical adjustments with respect to the amelioration of passive rotational versus lateral-flexion end-range asymmetries in otherwise asymptomatic subjects. J Manipulative Physiol Ther, 1992;15:99-105.
- Nansel DD, Waldorf T, Cooperstein R. Time course effect of cervical spinal adjustments on lumbar paraspinal muscle tone: evidence for facilitation of intersegmental tonic neck reflexes. J Manipulative Physiol Ther, 1993;16(2):91-5.
- Cramer GD, et al. The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Spine 2002;27:2459-66.
- Lehman GJ, McGill SM. The influence of a chiropractic manipulation on lumbar kinematics and electromyography during simple and complex tasks: a case study. J Manipulative Physiol Ther, 1999;22:576-81.
- Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech, 2001;16:293-9.
- Fitz-Ritson D. Cervicogenic vertigo. J Manipulative Physiol Ther, 1991;14(3):193-98.
- Di Duro JO. Improvement in hearing after chiropractic care: a case series. Chiro Osteop, 2006;14(2):1-7. www.chiroandosteo.com/content/14/1/2.
- Nansel D, Szlazak M. Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease. J Manipulative Physiol Ther. 1995;18:379-97.
- Seaman DR, Winterstein JF. Dysafferentation, a novel term to describe the neuropathophysiological effects of joint complex dysfunction: a look at likely mechanisms of symptom generation. J Manipulative Physiol Ther, 1998;21(4):267-80.
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