This is a brief post dedicated to the sceptics. I think it’s a valuable thing to do as it would be wrong of me to assume that everyone understands and appreciate where chiropractors get their ideas from. The simple fact is that it isn’t straightforward, nor in line with generally held beliefs.

First I should state that as a chiropractor, I look at back pain, neck pain, sciatica or in fact any injury or problem as they present in my clinic as an effect with a cause. True, sometimes an injury is just that. But in those cases the body will usually cope and self-regulate perfectly well. Sometimes the injury is so extensive that external help is required. This is where medicine does wonders. But some of the time, and it is impossible for me to say how much of the time as the studies just don’t exist, there is something which either undermines the normal recovery from an injury, or actually allows it or even causes it.

That, and that alone is what I am interested in as a chiropractor. When a body works well and should recover by itself, I believe that it should be left alone to do what it does best and has done for eons.

So what is this magical “something” that makes it go wrong? Think of it as a destructive process. A process which may, and often has, many heads. Those heads will collude and undermine the normal biomechanical uses of body parts and slowly but surely undermine the structural integrity of the body part put under stress. I say slowly but mean that figuratively. In fact my understanding from clinical findings is that there is a direct correlation between the severity of the “deviation form the norm” and the speed at which things deteriorate. It is quite logical really. The more abnormal the stress, the more excessive the stress. The lower the tolerance to stress, the more readily the stress will exceed the tolerance and cause or allow for injury. So, things can happen quite quickly, or they can take decades, but one thing is certain,… it will go wrong. And the statistics agree.

So the important thing is to understand the absolute value of “how wrong things are” and gain an insight to “how tolerant the system is”. Having an intimate understanding of these two sets of values is the key to predicting injury and recovery. In fact it is the application of this system that has made it possible for me to achieve a 98% success rate. But the key is knowing who needs treatment, who doesn’t, and who should get another form of treatment.

So, … the sceptics,… I think they are right on a number of levels, but wrong in their conclusions. the fact is that in my opinion a lot of people, and not just chiropractors, have undersold and missold their services for some time now. I have often heard people speak of trapped nerves and bones out of line causing nerve interference, then causing dysfunction and pain. Unfortunately I think that this is incorrect. I believe that much is gained from looking at the human body as a living, self-regulating system which requires little but by virtue of the sometimes harsh reality of living and that of living longer than ever before, will eventually require that little bit of help. That is if we want that living to be comfortable and optimal.

Chiropractors are in a great position and have the education and know-how to evaluate much of that self-regulating system and can pick up and identify what if anything is wrong with how it is doing things at a given point in time.

So, let’s think about back pain. Low back pain specifically. Many studies have been published on this topic, which is why I chose it. But the problem in many of these studies is that the data-analysis was done on “back pain”. And then they look at supplying a form of treatment and assess its benefits against another form of treatment or non-treatment and a placebo-treatment (a classic RCT).

But back pain is not an entity in itself. It’s just a symptom and this basically makes all such RCT’s invalid and useless. This fact often features in study conclusions.

Back pain can be caused by obesity, flat-footedness, lumbo-pelvic dysfunction, core muscle flacidity, injury, arthritis, post-surgical trauma, abdominal aorta aneurysm, and lots more. Chiropractioc manipulation or adjustments do not treat low back pain caused by aneurysms. Nor does it treat lowback pain caused by obesity. Aneurysm surgery and loosing weight on the other hand have the best outcome measures there. To make matters worse, it is often times not caused by a single agent, but multiple, and trying to distinguish them is not only tough but studying the value of different interacting agents is beyond what any such study has ever looked at.

So in a nutshell; chiropractic treatment has had its historical problems, but the point is that identifying causal agents and treating those causes correctly will get the results. When people (including chiropractors) offer treatment where the cause is not spinal biomechanical dysfunction, the results for manipulation are going to be dissapointing. Absolutely. But lots of people delude themselves that they treat this or that symptom where in fact they are all trying to treat an underlying type of dysfunction. Not assessing correctly whether the person presenting is in fact presenting with a pain or symptom which is primarily caused by the type of dysfunction they can treat, not only leads to dissapointing results but also to very unhappy patients. And that is that is where the sceptics come from. With the Patient Care Insurance I wanted to show to the public that there is another way of doing things and that there is reliability in the chiropractic product when it is used properly.

It’s a simple logic, with a lot of implications. Particularly for people who are working in the back pain field, but all of them worthwhile persuing. Allbeit difficult, and yes, sometimes complicated… More posts on this topic to follow.

I hope you found this piece interesting and if you have any comments you would like to make or questions you would like to ask, please do not hesitate to contact me.

Kind regards,

Stefaan Vossen, clinic director