I was in the supine position, arms at my side and the examining chiropractor placed his left hand on my anterior iliac spine on my right side while instructing me to raise my left leg.With my leg in the air, he instructed me to resist his efforts to force my leg down and out. Essentially he was testing the strength of my iliopsoas muscle. It was weak on the left but not weak on the right. After a few other muscles were tested, it was determined that the left sacroiliac joint needed a good side posture adjustment (including a significant rotary component to the adjustive procedure). Post-treatment tests found all muscles previously weak, now strong.
Sound familiar? This appears to be a strong validation for chiropractic care being beneficial. Let me share a later experience.
I was in the same supine position with the same examination procedure being conducted. The specified muscle was again found weak. This time the doctor adjusted my tarsal navicular and found the weak muscles strengthened. I then stood and walked about 10 feet, resumed the supine position and the muscle returned to a weakened state. The adjustment revisited and muscle strength returned. This time my foot was supported with a piece of athletic tape and the muscle strength remained after walking about. Was it a sacroiliac problem or a navicular problem?
On yet another occasion the same test was conducted with the same findings. The treatment, high-voltage at a very specific frequency, (considered the key to the success of the treatment) was applied to the forehead. It resulted in strengthening of the weakened muscles. Do I assume that my internal frequencies are out of synchronization thus throwing my sacroiliac and navicular out of adjustment?
Continuing the saga with essentially the same positive muscle tests, results came from a non-force thumb thrust to the L-4 spinous. And of course I have been shown to demonstrate numerous nutritional deficiencies, uncleared neurovascular and neurolymphatic points, disturbed energy meridians and unbalanced magnetic polarities, a result of this same examination procedure.
Why do I continue to demonstrate abnormal findings on examination attributed to a wide variety of problems, (as explained by the competent and sincere examiner), but easily corrected irrespective of what therapeutic measure is applied? Is there something wrong with the process? Is there fault in the examination process? Are there inadequacies in the explanation of causality? Is the therapy adequate and if so why do the positive findings persist? Are the positive post-treatment outcomes meaningful?
These are penetrating questions of which the answers may pose a threat to the beliefs of those who sincerely apply these methods. It is not my intent to demean or make light of what I have experienced. Rather, I would extend a challenge to the profession to support efforts to seek a more sound understanding of what we do as chiropractors and what it really means to the health of our patients. Were this an easy task, it might already have been accomplished. Let me explain.
There are fundamental questions contained in the above scenarios:
Do we adequately understand the mechanisms behind the outward signs demonstrated by what we do? How valid are the explanations we use to explain those mechanisms?
Are the procedures we utilize applied in a reliable and repeatable fashion? Can two of us use the same procedures and agree that we obtained the same findings or results?
Is what we do for our patients beneficial to their health, their health care costs and their quality of life?
Is the care we give them better than some other care or no care at all?
In research terminology, the above four questions are from antiquity. They address the issues of validity, reliability and efficacy. They are not unique to chiropractic. As civilization has crawled from the murky swamps of the dark ages, slowly, ever so slowly, knowledge has superseded superstition. Yet we live in a world of stark contrast between the fruits of rigorous scientific investigation -- the technological milieu, and a strong emotional attachment to belief systems absent of scientific evidence.
Thirty percent of the population in the U.S. seek health care from non-traditional providers (usually considered to be non-evidence based). Interestingly, much of what is done in traditional medicine lacks evidence. So in chiropractic, do we cast ourselves adrift in the sea of ignorance claiming we are no worse off than the rest of the health care world? Or, do we seek a safe harbor of knowledge that can protect us against the winds and waves of skepticism and cynicism?
In our profession, I find a much needed blend of science and faith. Science, in all its beautiful adornment, is still a youngster among the world's ideologies. Where its principles are properly applied, we can gain great strength and confidence. When confronted with the limitations of strict scientific rigors, we must step forward on the basis of rational critical thinking supported by logic. At times, faith may be the only resolve, but conclusions generally should be applied only to individual circumstances and not forced upon others, especially those of differing faiths.
As a profession seeking to provide the best of care to our patients, we must strive to provide scientific support to questions of validity, reliability and efficacy. We must continue to conduct randomized controlled clinical trials, collect case studies, surveys and publish information about what we do. Where information is deficient, rational critical thinking based on logic must be applied to what we do for our patients. We should not be vulnerable to every new technique or philosophy or practice management procedure that is advertised, without a thorough critical investigation of what they represent.
Finally, it is our personal faith in what we do that helps our patients build confidence in us as providers of their health care. If we don't believe in what we do, how can we expect others to have any confidence in us. But we must remember that faith is a personal thing and we cannot nor should we attempt or expect our patients to acquire and accept our beliefs. They may gain confidence because we have faith, but their faith to be healed must come from within them, and be based on their own experiences.
Scientific knowledge, rational critical thinking, and faith are essential to success in practice and success as a profession. The absence of any one of these component creates a two-legged stool. I urge that the profession seek the answers to the three basic questions: validity, reliability, and efficacy. That is how we can all build our faith and strengthen the logic to support our critical thinking abilities.
The aim of science is not to open the door to everlasting error.
Reed Phillips, DC, PhD
President, Los Angeles College of Chiropractic
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