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Dynamic Chiropractic – November 18, 1996, Vol. 14, Issue 24

Evaluating Chiropractic Research Data: What Have We Missed?

The General Situation

By Jesse Jutkowitz
Chiropractic was discovered in the same way most medicines and other useful treatments were discovered. One person (Dr. Palmer) encountered another person (Mr. Lillard) who had a problem they wanted to correct. Dr. Palmer listened to the history of Mr. Lillard, that he had gone deaf after hearing a pop in his back while lifting something. The history included a comment about a hard lump that developed in Mr. Lillard's spine where he heard the pop. Dr. Palmer put two and two together that a bone popped out of place and Mr. Lillard went deaf and thought maybe his hearing would return if it was pushed back into place. Dr. Palmer pushed the bone back into position and Mr. Lillard did get his hearing back afterward. Two and two did add up to four.

That sequence of discovery was not really that much different from the discovery of antibiotics or other medicines: people discovered germs cause illness; someone working in a lab noticed germs don't grow near green mold and figured there must be something in the mold that kills germs; that it could probably be used to help fight infection, etc.

Dr. Palmer went on to theorize that out-of-place bones resulted in pinched nerves and body malfunctions, resulting in all different types of health problems. He was pleased when his experiments demonstrated that improving the mechanics of the spine improved people's health in regards to back and neck pain, but more importantly it improved things like heart problems and other internal disorders not thought to be related to body mechanics.

These theories were not the imaginings of some "wacko." Examination of his writings shows Dr. Palmer was an up-to-date, modern researcher for his time (late 1800s early 1900s). Medical doctors of that time were still using blood-letting as a major method of treatment. Dr. Palmer deplored that approach and the using of "... tinctures and lotions of all known vegetables and crawling creatures," as well as bleeding and other mystical healing. Dr. Palmer wanted an answer to "... why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not." He took good histories and kept good records of his cases and research from which he drew his conclusions.

Palmer's chiropractic therapy worked well on many, and for much more than back or neck pain, but did not work consistently and predictably. That was a problem Dr. Palmer recognized as a lack of information on what was happening with the patients. At that point he just did not have enough information to definitively figure what to do with each individual patient. He also recognized that should improve with time and research.

The theft of his ideas and other intellectual property by his son B.J., along with the uninvestigated theories put forth by B.J. which tended to be illogical and inconsistent with known observations, galled Dr. Palmer terribly. This is made plain in the preface he wrote (1910) to his book, The Chiropractic Adjuster.

There have been several attempts to improve on the basics of chiropractic: that a bone (or more) is out of place, preventing the body from working properly, allowing infection and disease; to reposition the bone to let the body heal itself. The first improvement occurred a decade or two into the 1900s: the institution of a thorough education in anatomy, so the chiropractic doctor would know bone positioning and recognize when one was out of place. The next occurred in the mid 1900s: the use of x-rays to measure the spine and determine what was out of position. That is where chiropractic got itself stuck. Many things were and still are taught that Dr. Palmer noted were "... errors which, through stolid ignorance, have been taught and accepted as integral and necessary parts of chiropractic."

Over the last century, experience has shown that basic chiropractic is actually a very workable theory with millions recovering from diseases and mechanical pains said to be "incurable." Even the medical profession has come around to admitting it. Yet chiropractic treatment still misses its goal far too often.

The Problems

X-ray was supposed to be the answer getting more information so chiropractic would work more predictably and consistently. The problem is that chiropractors, osteopaths, MDs, and PTs look at the spine from the front on view as it appears on the x-rays without thinking of it as a three dimensional working object as it exists in reality.

The Office Today

Supposedly, the two dimensional point-of-view problem is solved by taking front and side view x-rays. But most doctors and researchers still look at only the front view of the spine, because that is how they look at people: front-on.

Even today, modern medical and chiropractic studies of scoliosis are done using only front view films. They measure the degree of side-to-side curvature without accounting for the three dimensional twist of the entire spine. Doctors know the ideal spine should be straight up and down when viewed from the front or back. It is simple and easiest to understand without having to take into account the curves that are supposed to be seen on the side view x-rays.

Doctors do not realize that these curves most often show on the front views because of the three dimensional twisting. Most doctors take the easy route, looking at the very limited front-on point-of-view, even while admitting its shortcomings, because they do not understand how to figure what is happening on the side views.

Resulting from that view is the theory to directly push the bones into a better position. If it is out of place left, push it right; if it is right, push it left, etc. That theory creates a problem. The three dimensional spinal column never moves just right or left. Anyone truly knowledgeable in the study of kinesiology (the study of motion in humans) will tell you it is impossible to bend to either side without some normal twisting in various parts of the spine. As the spine moves or tilts it always moves in a twisting motion. Even when bending straight forward or backward the bones move in a slight twisting motion to increase the fluidity of motion.

In the '50s and through the late '70s, most chiropractors and chiropractic researchers recognized the entire spine moved in a synchronized fashion with one part moving and changing in response to changes caused by motion of other parts. They used x-rays of the entire spine to show how treatments of various types changed the spine for the better; to develop a treatment system that would make chiropractic work more consistently and predictably. It has not worked out so far, and there are good reasons.

Besides not truly viewing the spine and considering its motion in three dimensions (though giving lip service to doing so), another major stumbling block was and is the basic idea that x-rays should be taken in the standing position . The assumption is that standing is the natural position of man and the position in which the problems would most accurately show. That basic presupposition, still used by most doctors and researchers in chiropractic, medicine and physical therapy, is false and has misled many doctors and researchers.

In the standing position human beings can most effectively use their legs and the large muscles, attaching from the legs and pelvis to the spine, to twist the spine and pelvis into the best position possible to compensate for their mechanical problems, and to keep upright. When sitting, bending, or lying, humans lose most of that ability to compensate, because the legs are not planted firmly and are no longer a stable base from which the spine can be supported by those muscles. This is why many people twist with their legs under themselves to sit. The twist of the legs better supports and compensates their mechanical problems. They are more comfortable with the legs twisted in that manner and do not understand those who ask how they can be comfortable doing it. It's natural to them to get themselves into a more comfortable position and beyond their experience that sitting straight with the feet flat on the floor can do so. Yet after treatment that truly improves their biomechanics, you immediately find these same patients sitting straight and comfortably without their legs twisted with no prompting.

When it is pointed out to them that they are currently sitting straight and comfortably, they are either stunned by the realization that they have truly been improved, or they are now so naturally comfortable in that position they often insist it has always been so. Their statement often astounds those who have been exhorting them to "sit straight" for decades.

Back to the research that did not work out. In most cases, front view x-rays taken after a period of treatments on patients who were feeling and moving better, showed no changes or greater side to side curves. Doctors did not know what to do. That observation was undeniable but did not fit the theory of "chiropractic adjustments straighten the spine and get the patients better." It negated that theory.

On the other hand, it was readily apparent to all that the patients were truly improved. The patients knew they felt and moved better and the physical examinations and orthopedic tests showed the doctors that the patients were better and had greater range of motion in the area that hurt, even with "no changes or bigger spinal curves on the posttreatment x-ray."

Not understanding that the spine was straightening by unwinding itself in three dimensions, and fearing that the greater curves on the front view (AP views) films after treatment would lead to greater criticism, chiropractors stopped taking posttreatment films rather than modifying their theories and doing more full spine research. The chiropractic political leadership made it policy to discourage pre- and posttreatment x-rays, and imposed license suspensions on doctors who did take pre- and posttreatment x-rays of their patients. This persecution was out of fear that the profession would be invalidated. This started what will be known as the "Dark Ages of Chiropractic."

Just as in the European Dark Ages, this was a time when people who did not understand were politically powerful. Out of fear, those in power forced students, doctors and researchers not to look at information (pre- and posttreatment films), rather than have to deal with the unknown or change the imposed beliefs. They tried to destroy those who defied them and were often successful. It has been a continuing reign of terror over the profession.

Next time: How the mistaken belief of "medical oriented" chiropractors (that pre- and posttreatment x-ray showing greater curves posttreatment indicates that measuring mechanics on x-ray is invalid) damages chiropractic and prevents our progress; how those pushing chiropractic philosophy to the exclusion of all else (without researching pre- and posttreatment radiographic validation) are causing our profession just as much damage, and holding us back just as much; and what can and should be done about it.

Jesse Jutkowitz, DC
Milford, Connecticut

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