Looking Out Instead of Looking In

By Dr Henri Marcoux

During my 4 years at CMCC, I was exposed to very competent clinical training taught by caring qualified teachers, most of whom were Chiropractors. Technique was especially excellent. The Class of 66 was exposed to Palmer HIO, Gonstead, SOT, Gillet's Motion Palpation, George Goodheart and early AK, plus the technique styles of Dr Denny "move dat bone" Bennett and Dr Ron Watkins, the Clinic Director. We also had great exposure to DD Palmer's philosophy from Dean Dr Marsh Himes, contemporary to BJ Palmer and ex-professor of Philosophy at Palmer School of Chiropractic.

I was most impressed with Dr Gillet's seminar in my 4th year. I adopted this approach and integrated it with all I had learned up to that point.

These Chiropractic giants, especially Dr's Watkins and Himes, taught the Chiropractic premise that disease and illness was a result of a loss of normal body function controlled directly and indirectly by the nervous system. They taught that alterations in the normal function of the spine, especially through the presence of "vertebral subluxations" would cause "interference" by disturbing the function in the nervous system thus altering body functions. These gentlemen also taught that the purpose of Chiropractic care was the removal of factors interfering with normal neurological function by a variety of judiciously applied spinal adjustments that had stood the test of time and proven themselves in practice.

Soon after beginning my practice, I became aware that focusing on symptom relief care and the area of complaint did not address the reality that when one spinal segment is subluxated, the whole spine is involved. Although I was using full spine techniques, I was compelled to start looking deeper in the spine itself for more than fixations and making patients feel better. I was looking to understand DD Palmer's Chiropractic and I felt that I was lacking the tools to do this. I wanted to see greater changes in the inborn ability of the body to heal itself. I started to look for different ways of assessing the spine and nervous system. I focused more on the upper cervical spine and started to refine my technique. This was intriguing because changing my technique brought different responses and results. This was exciting, but it left me wanting more.

I reasoned that if I understood more of the clinical manifestations of the "subluxation", I would do better work and get better results. Joint bio-mechanics became very interesting and I started to focus on joint conditions using more orthodox "scientific" diagnostic procedures. Consequently, I started focusing more on the symptoms, the associated clinical conditions, and articular patho-mechanics and the correction of these spinal problems. I thought that this is where I would find the "cause" of the spinal dysfunctions and a greater understanding of Palmer's Chiropractic. I started looking "outwards".

In my thirst for more knowledge, I founded the Agassiz Chiropractic Orthopedic Society in 1970 to obtain my certification in Chiropractic Orthopedics. I became a Diplomate of the American Board of Chiropractic Orthopedics in 1975. At this point in my career, I fully embraced and promoted what I thought was Chiropractic Science and developed an expertise in Spinal Manipulative Therapy (SMT). In 1975, after contacting the CCA to form a College of Chiropractic Orthopedists, I was invited to become a founding member and Fellow of the College of Chiropractic Science through CMCC.

For 5 years after DABCO certification and as a Fellow of the CCS, I focused my practice into the Chiropractic Orthopedic model of symptom relief care and joint disease prevention. My treatment plan consisted of treating the joint problem and then providing longer term care to prevent re-occurrence of symptoms. This led me into some research into many clinical areas including nutrition, hypoglycemia and postural syndromes and developed new manipulative techniques. I felt my clinical work was excellent. However, I knew that I was still missing something fundamental in my delivery of Chiropractic care. I found with remarkable consistency, that by focusing mainly symptom relief care, the accompanying dysfunctional spinal conditions would, over time, continue to degenerate unabated. This was especially evident in those patients who came for care whenever their symptoms would flare up. These patients felt better while their degenerations were silently moving right along.

On the other hand, those patients to whom I was administering long term corrective care, in spite of my symptom oriented techniques, experienced significant life changes, especially in quality of life, and showed a slowing or stopping of spinal degeneration. It became clear to me that spinal subluxations, by any definition, were doomed to degenerate as long as generalized spinal dysfunction prevailed. This justified long term care beyond symptom relief to correct the fundamental problem. I went for it.

Right from the outset of my practice experience, I was very aware that patients with acute symptoms, even those with injuries, were also suffering from negative stress in their lives. I did know about the dynamics of the body/mind at that time, but I knew that these stresses were somehow associated to the cause of their symptoms. It was obvious to me that emotional stress was a postural affair. I became aware that the techniques I was using would not address these more wholistic clinical considerations. I changed my technique dramatically and started to see different results.

I started to understand this reality more clearly in the mid 1970's, when I was able to study the relation of posture, emotions and personality under Dr Alexander Lowen, founder and developer of Bioenergetics Analysis. I became very conscious of how the body converts emotional energy into postural holding patterns which lead to symptoms. I realized much later in the early 1990's that the spinal cord played a major role in converting emotional stress into spinal stress. I became aware of Dr. Breig's work

It was after studying with Dr Lowen that my practice and my technique really changed. I started to look for techniques that would deliver what I was looking for. I attended many seminars both in practice management and technique. I was exposed to a great variety of techniques, such as Upper Cervical techniques as taught by Pettibon, Kale, and others. I also studied Activator Methods, AK, CK, Torque Release, Network Chiropractic and read and experimented with many other systems.

From this exploration and experience, I gained a clear understanding that the most significant Chiropractic techniques utilized the functional neurology inherent to spinal dynamics, rather than the mechanics, the fixations and the misalignments of the spine to determine what to adjust and when not to adjust. At first, I could not believe that an upper cervical adjustment was so effective in relieving acute lower back pain. There were many more such phenomena where organic symptoms would change or disappear.

The techniques that focus mainly on faulty joint patho-mechanics without analyzing spinal reflexes usually do not get the same results as their more vitalistic counter-parts. Contrary to popular belief, it is the clinical recognition of this neurological expression, including leg length monitoring, that gives the clearest analysis of spinal dynamics and the correct identification of subluxations and associated postural patterns. The ever-popular fixation model and/or the misalignment models represent only a minor aspect of the subluxation complex and as such, is more closely allied to the medical model than to the Chiropractic model.

Through the experiences described above, I have gained a great respect for Chiropractic as a Philosophy, an Art and a Science. Because of the wholistic/vitalistic nature of Chiropractic, these three facets of our profession form a congruency that is generally not found in the allopathic approach to Chiropractic care. I have found that using techniques that focus on restoration of function and the correction of subluxation patterns, rather than manipulating joint conditions, more than adequately relieves symptoms. There are exceptions, of course. Many patients consult us with sprains and strains of extremities especially, that demand the type of direct intervention that Chiropractors provide.

If we separate the Philosophy, the Science and the Art of Chiropractic, we lose our direction and intent and start to focus on the symptom or the joint condition. We medicalize Chiropractic when we focus on the crisis rather than try to identify any and all causal factors. If the Chiropractor is separated from a basic understanding of Chiropractic Philosophy, she loses her goals and the Art and the Science weaken. The Art of Chiropractic is most clearly shown in our skilled application of techniques, whereas the Science gives us the means to reproduce and the tools to advance our understanding of Chiropractic. Many in our profession want to separate the philosophy from Chiropractic rather than allow the philosophy to evolve, grow and change into new understanding. In my experience, this is not logical and certainly not scientific.

In our recent history, the use of the term "manipulation" is used to identify what Chiropractors do. This popularity became important to the academics in our Chiropractic Institutions. While many of our structural techniques can be identified as a "manipulation" in the broadest sense of the word, the term is not Chiropractic lexicon. The word "manipulation" applied to Chiropractic gained immense popularity in the 70's with the writings of a number of Medical manipulators, including Cyriax, Mennell and Maigne, who, for many years, were the pre-eminent Medical manipulators. Many of our academics and institutions adopted this terminology along with the notion that the vertebral fixation and misalignment represented the vertebral subluxation. While the use of this term gives us more medical credibility, it also alienates us from our clinical heritage.

In this context, many of our institutions went from the teaching of established subluxation based Chiropractic (correcting function) to the "scientific" manipulation of vertebral fixations to relieve pain. Available research made a strong case for lower back pain manipulation as being more effective than drugs or surgery. The other non-manipulative Chiropractic techniques suddenly became secondary, unimportant or identified as being part of the "non-scientific" group of Chiropractic techniques. Many of these techniques are now called the "emerging" techniques, while others are simply ignored as being "philosophical".

I believe that adopting spinal manipulation at the expense of the Chiropractic adjustment is equivalent of throwing out the baby and keeping the bath water.

Many Chiropractors use the term "manipulation" to mean the same as "Chiropractic adjustment". The fact is that a "manipulation" is not the same as an "adjustment". While a "manipulation" may resemble a structural "adjustment", it focuses almost entirely on the joint or motor unit component of a vertebral fixation or a misalignment. On the other hand, an "adjustment" may be structural by causing spinal joint cavitation using a high velocity, low amplitude force, or variations thereof, or it may be a low force contact, a light force directional contact, a toggle type thrust, a stretching contact, a ligamentous stretch, postural repositioning, a vibratory impulse, different varieties of adjusting instruments, or a sustained pressure contact, to mention some of the possibilities. In addition to this, the assessment process to determine which segment to be adjusted and the type of adjustment to be given goes far beyond the fixation theory of subluxation. To access these different types of adjustments requires an understanding of the functional neurology of the spine, common to these techniques.

This art of analyzing subluxations is lost to graduates of the last 15 years. This incongruence is often manifested in new graduates who consider treatment plans beyond symptom relief to be "over-treatment". This flies in the face of common sense, logic and the basic knowledge that the spine and posture are the central holding elements to the embodiment of the whole person and that the nervous system is intimately involved in this process. In fact the entire spectrum of the human experience, especially in our emotions and stress relies extensively in the neuro-dynamics of spinal function.

All feelings are physical and involve the spinal cord and its relationship to the Musculo-skeletal system.

Many academics and scientific practitioners refer to Chiropractic Philosophy as "Chiropractic Theology "or "Chiropractic Theosophy" among other disparaging remarks. The use of the terms "Innate Intelligence" or "Universal Intelligence" sparks negative reactions in this group of Chiropractors. Unless we understand the contextual semantics of our original lexicon, we cannot advance and evolve these original Philosophical considerations and into our current context and culture. It is interesting to note that our term "Innate Intelligence" or "Body Wisdom" is in common usage in many other professions linked to healing and the restoration of health, including the Medical profession. That life is a manifestation of intelligence is not new to the scientific world. Stephen W. Hawking in his "A Brief History Of Time " (1988) writes explicitly about "reading the mind of God".

Albert Einstein said "Where the world ceases to be the scene of our personal hopes and wishes, where we face it as free beings, admiring, asking and observing, there we enter the realm of art and science." Einstein was aware that Science and Art couldn't be separated. So did DD Palmer.

David Daniel Palmer developed his theories based on his personal culture, his societal context and available knowledge for his time. While we have no evidence that Palmer was aware of Max Planck (Quantum Physics) and Albert Einstein (Theory of Relativity), two of most influential physicists in his and of our time, Palmer's use of 350 references in his 1910 publication suggests strongly that Palmer was in touch with the broader scientific community of his day. Albert Einstein who disclosed the Theory of Relativity in 1905 was also known and published as a mystic in his own right. The Theory of Relativity is not regarded as theology or a Judaic spiritual concept. The concepts around Chiropractic's "Innate Intelligence" are not theology but the substance around which we need to direct our research. Like his contemporaries, DD Palmer simply acknowledged that life was a manifestation of intelligence in a lexicon called Chiropractic..

In Palmer's "THE CHIROPRACTOR'S ADJUSTOR", page 8, DD he states "Chiropractic is the name of a systematized knowledge of the science of life—biology, and a methodical comprehension and application of adjusting anatomical displacements, the cause of biological abnormalities; also an explanation of the methods used to relieve humanity of suffering and the prolonging of life, thereby making this stage of existence much more efficient in its preparation for the next step—the life beyond". Does this sound like a "Quality of Life" consideration? Palmer was aware that humans were made up of physical, mental, emotional and spiritual components and that the spine and nervous system played a role in creating quality of life and health. In this time of great scientific awareness, the concept of the Body/Mind/Spirit is completely acceptable in scientific circles everywhere.

Some Chiropractors see Science as a master and invent scientific dogma. "Scientism" is the religion of scientific dogmatism. Scientific reductionism falls into this category. Reductionistic science violates wholistic/vitalistic sciences such as Chiropractic. Reductionism may work in inert matter, but does not work efficiently in living matter. RCT's do not work in a scientific explanation of the phenomenon called Chiropractic.

There are also Chiropractors who see Philosophy as a master and this turns a Science, Philosophy and Art into an incongruent dogmatic mess. This is also a religion. There are probably as many Chiropractors who are philosophical fanatics as there are Chiropractors who are practitioners of "scientism". Both of these camps do not represent the greatest majority of Chiropractors. Congruent Chiropractic is alive and well in varying degrees among practitioners of symptom relief care as much as it is in subluxation-based or corrective care Chiropractors.

Many in our profession have lost the sense of what symptoms really are. In my experience, symptoms are never the problem, as annoying as these can be. Symptoms are always the manifestation of an underlying problem somewhere in the system that can be readily detected usually when there is a correct interpretation of the physical signs. Knowing how to interpret these signals provides a key to determining what to adjust, when to adjust and how to adjust. With this approach symptoms disappear easily and the use of therapeutic modalities becomes unimportant.

Strict focus on the mechanical aspects of spinal function mostly eliminates assessment and analytical information about the many functional neurological reflexes present in spinal mechanics.

This Neurological Chiropractic approach is a far cry from SMT where the principle criterion is a loss of normal motion and/or a misalignment. In my view, a fixation is put there by the body and should rarely be adjusted, especially if the fixation is bilateral. The body, in its wisdom, has put a "stop" to segmental motion for a good reason. Structurally adjusting fixations, especially the bilateral ones, constitutes a "manipulation". Our work is to find the reason, the cause. Using misalignment alone as a clinical justification to manipulate is also a violation of the body's wisdom. There are many factors that need to be considered before correcting the spine. Using the functional neurology inherent to the spine is the best tool to do this.

This may surprise many Chiropractors, but Dr Gillet, the founder of Motion Palpation, never adjusted a spinal segment that could not move in one plane or another. He usually adjusted in the direction the vertebra could move. In fact, very often he looked for what was causing the fixation in the upper and lower extremities and adjusted those subluxations. Many of his adjustments involved the stretching of ligaments and sustained contacts.

A correctly given spinal adjustment will create "ease" in the spine and the whole person. The patient leaves the office feeling that something has changed inside her. "Ease" is characterized by a feeling of inner peace accompanied by a sense of profound relaxation and more flexibility. Often she will describe a sense of feeling taller. The doctor will appreciate a palpable relaxation in the spine along with a measurable change in the clinical parameters. This phenomenon is related to the fact that body function is more normal, as shown through the spine. Patients become considerably less concerned about their symptoms, knowing that there is a "movement" or a change occurring in the condition. In my experience, symptom relief care, while being very helpful, rarely creates "ease". Healing can only occur when there is "ease" or a restoration of a more normal function in the nervous system.

All stressors, especially those where a "flight or fight" pattern is elicited, land in the posture and alter spinal dynamics. Altered spinal function manifests subluxation patterns and postural changes. When we fail to adapt to these patterns of altered function, the body gives us signals or symptoms. Symptoms are agents of change. They tell us that something in our life has to change.

When questioned, patients will admit that symptoms are usually not the real problem they are seeking to correct. Symptoms become a problem when that patient is not able to live her life they way she would like to. Not being able to golf, pick up her grandchild, or go to her work affect her more than symptoms that do not incapacitate her. As long as quality of life is not affected, patients can and will live with symptoms (and OTC's) indefinitely.

When the degenerative process has stopped or slowed down in the spine, the body will actually seek to reconstruct itself with continuing care. In due time, the body will create a "new normal". This new self is characterized best a being "wellness". Wellness is not about a symptom-free existence. It is more about being able to recover and learn quickly from the experiences life throws our way. This is where properly applied Chiropractic fits in.

Using current biofeedback technology, we can actually show that Chiropractic has a profound effect on the central nervous system. Measuring EEG, EKG, GSR, sEMG, skin temperature, Heart Rate Variability (HRV) and respiratory amplitude and rate, it is possible to correctly identify that the CNS has been influenced. This is especially evident when an "adjustment" is given versus the giving a "manipulation". Correctly applied adjustments will increase alpha waves, slow the heart rate, relax muscles, deepen the breathe, reduce sympathetic tone, increase parasympathetic tone, create warmth in the extremities and add higher coherence to HRV. These findings are a manifestation of "Ease". A manipulation applied to a fixation without the proper neurological considerations has a reversed effect. The "ease" disappears and is replaced by tension and stress. Using modern technology found in the InVision (Thought Technology) it is easy to demonstrate this occurrence. This really helps a Chiropractor change his technique to an approach that gets different results. This can be very upsetting especially when you think that what you are doing affects the CNS in a positive manner.

I have briefly outlined a synopsis of my 38 years as a Chiropractor. I found what I was looking for in the Early 1990's at a time when I was thinking of leaving the profession. It has taken me a long time to finally "get" what the work is about and deliver the promise and the intent of Chiropractic. How can we be aware of the limitations in Chiropractic if we cannot appreciate the greatness of this work?

Dr Marcoux practices in Winnipeg and can be reached by email at marcouxchiropractic@shaw.ca