Congruent Chiropractic

Henri Marcoux DC, DABCO, FCCO(c)

For several years after graduating in 1966, I thought segmental vertebral fixations and misalignments were the classical vertebral subluxations described in the Chiropractic textbooks I had either read or referenced. I was taught that these subluxations caused "interference" in the nervous system that lead to abnormal function, failure to adapt, symptoms, and was a major cause of disease. I could see how vertebral joint malfunction and misalignment could cause symptoms. I could not see how this could significantly influence the nervous system to cause disease, taught as a manifestation of abnormal function.

One day in 1968 I adjusted a 17 year old boy who had chronic asthma, severe sinusitis, and constant colds. Gilbert had been using enormous amounts of anti-histamine spray, puffers and Aspirin to relieve his constant pain and upper respiratory congestion. My examination revealed a marked misalignment and fixation at C1 which I promptly adjusted. Within minutes following that C1 correction he started to cough and produce enormous quantities of yellowish mucous streaked with red blood. For the first time in years, this young man felt much wanted relief of his symptoms. This expulsion of mucous and phlegm continued to occur for the next few days, especially after his subsequent adjustments.

This dramatic event motivated me to seek a deeper understanding of Chiropractic. From that moment on I adopted an office oriented evidence-based approach that allowed me to categorize my experience and observations. This clinical methodology permitted me to develop "best practice" protocols that were grounded on real time results as opposed to relying on personal beliefs and convictions. This methodology also forced me to seek answers to so many questions that kept coming up every time I had results I could not explain.

As a result of a significant number of changes and new directions I was forced to embrace because of my curiosity and desire to leave no "stones unturned", I came to the understanding that Chiropractic practice was much more than simply a science. Over time I came to understand some very basic factors about how the art and principles inherent to the practice of Chiropractic supported the science. These realizations forced me to view things differently and drove me to dramatically change my style of practice at least 6 times, each time adopting a different view of what I thought Chiropractic was about.

40+ years of clinical experience has given me a great respect for Chiropractic as a philosophy, an art and a science. These three facets of our profession form a congruency that is generally not found in the more conventional or allopathic approach to health. I have learned that this triad forms the essence of what is required to get the best results and accomplish the most in practice. If we segregate the philosophy from the science and the art of Chiropractic, we lose both the art and the science and if we segregate the art from the science and philosophy we lose both the science and philosophy. This inherent congruency forms the basis that allows all three aspects of Chiropractic to flourish. The science allows us to develop the techniques that produce the art of Chiropractic. The art allows us to deepen the science and the philosophy provides directions for both the art and science. These three principles support one another in all aspects of practice.

If we lose this congruency, we start focusing on the symptoms or the joint conditions, and we lose the wholeness of person in the process.

Having studied a significant variety of technique systems, has allowed me to employ many different techniques, including the development of a number of new techniques and clinical approaches. My opinion, based on clinical experience, is that those techniques that produce the best results overall, including symptom relief, were based on understanding the functional neurology inherent to spinal dynamics. I have found that those techniques that focus mainly on faulty joint patho-mechanics without analyzing spinal reflexes usually do not get the same results as the more neurologically based systems common to more vitalistic practices.

The clinical recognition of the functional neurology of the spine gives a clear analysis of spinal dynamics and is important for the correct identification of vertebral subluxations and their associated postural patterns. The ever-popular fixation model or the misalignment model represents only a minor aspect of the complex nature of spinal dynamics by placing a strong emphasis on spinal joint derangement or malfunction without due consideration to the associated spinal neurodynamics. This approach is more closely allied to the medical model of treating disease rather than the chiropractic model of restoring function.

The key point in this consideration is that if there is a subluxation anywhere in the spine, the whole spine is subluxated. The slightest alteration of segmental function creates an alteration of the entire spinal mechanism. Understanding this phenomenon opens the door to grasping the clinical components of neurologically based spinal analysis and its Chiropractic applications. If the intervention we provide causes a restoration of more normal spinal function, then we have "adjusted" the body's inherent ability to seek homeostasis and to reorganize towards normal function. The body's organizational skills will address symptomatic spinal joint problems directly.

Currently, the term "manipulation" is commonly used to identify what we do. 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 under the influence of a number of Medical manipulators, including Cyriax, Mennell and Maigne and others, 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 seems to give us more medical and/or scientific credibility, it also serves to alienate us from our Chiropractic clinical heritage.

In this context, the majority of our educational institutions went from teaching established subluxation and neurologically based Chiropractic adjustive techniques and systems to the mechanical manipulation of vertebral fixations to relieve symptoms. Some significant clinical research made a strong case for spinal manipulation as being more effective than drugs or surgery in relieving lower back pain. This had a strong influence on many of our institutions to start advocating spinal manipulative techniques (and the terminology) to relieve pain because research supported this and seemed to give us more credibility.

It is my opinion that adopting "spinal manipulation" at the expense of the Chiropractic "adjustment" is equivalent of throwing out the baby with 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".

A "manipulation" used in a chiropractic context is a structural correction, using a high velocity, low amplitude thrust focused on the correction of a joint or motor unit dysfunction identified as a fixation or a misalignment. There is usually a cavitation of the manipulated joint signifying an articular movement and a subsequent structural change.

An "adjustment" may also be structural causing spinal joint cavitation using a high velocity, low amplitude force, but it may also 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, a variety of light thrusts from a number of adjusting instruments, a thrust with torque, or a sustained pressure contact, among some of the possibilities. The goal of the adjustment, while corrective, is directed toward restoration of spinal function rather than the treatment of a joint condition or fixation. The cavitation of a joint is not a criterion, nor the goal in the delivery of an adjustment. An adjustment will demonstrate an effect on the whole spine that can be measured in spinal reflex neurology. As such, an adjustment goes beyond restoration of segmental dynamics and the relief of symptoms.

To access these different types of adjustments requires an understanding of the functional neurology of the spine, common to those techniques that are neurologically based. Unfortunately, these techniques and their analyses are no longer taught in most Chiropractic Colleges for the past 15 or more years.

In my experience, separating Chiropractic Science from the understanding of basic Chiropractic Philosophy causes us to lose our direction. It is the Art of Chiropractic that we lose. Chiropractic then becomes incongruent. 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 reality that the spine and posture are the central holding elements for the embodiment of the whole person. Furthermore, the spine and nervous system are intimately involved in the entire spectrum of the human experience, especially in our emotions and stress. Stress is a postural affair.

Many chiropractic academics and dogmatically scientific practitioners refer to Chiropractic Philosophy as "Chiropractic Theology" or "Chiropractic Theosophy" among other remarks intended to belittle Chiropractic philosophy. The terms "Innate Intelligence", "Universal Intelligence" and many other words and concepts that are part of our Chiropractic heritage are also commonly employed in many other scientific disciplines linked to healing and the restoration of health, including the Medical profession. Unless we understand the contextual semantics of our original lexicon and concepts, we cannot advance and evolve these original Philosophical considerations into our current context of scientific knowledge and culture. The understanding that life is a manifestation of intelligence and that the body is self organizing is not new to the scientific world.

True science seeks to understand the truth and will stand against politics. True science is a servant, not a master. It is a great tool at our disposal that can be used to understand nature and its marvels.

David Daniel Palmer developed his theories based on his personal emotional and spiritual culture, his societal context and available knowledge for his time. While we have no evidence that Palmer was in touch with Planck (1895, Quantum Physics) and Einstein (1905, 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, like D.D. Palmer, recognized that there was an organizing principle in the Universe and published his scientific considerations within the context of his personal considerations, both emotional and spiritual. The Theory of Relativity is not regarded as theology or a Judaic spiritual concept. The concepts around Chiropractic's "Innate Intelligence" are not theological and can be a basis for the humility required to do grounded, realistic scientifically sound Chiropractic research.

Palmer simply acknowledged that life was a manifestation of intelligence and elucidated principles to understand this aspect of life.

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." Palmer, likeEinstein was aware that Science and Art could not be separated.

In "THE CHIROPRACTOR'S ADJUSTOR", page 8, DD Palmer 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". This is a "Quality of Life" consideration. Palmer was aware that humans were physical, mental, emotional and spiritual beings and that the spine and nervous system played a role in creating a healthy adaptative response to all aspects of the life experience. Simply put, Palmer knew that there was an intimate relationship between the spine, the nervous system and quality of life. He advocated that health in all its attributes was a manifestation of good function over time. In our era of great scientific achievement, the concept of the Body/Mind/Spirit is completely acceptable in scientific circles.

Chiropractors who see science as a master create scientific dogma. "Scientism" is the religion of scientific dogmatism. Scientific reductionism falls into this category. Reductionism may work in inert matter, but does not work in highly variable living matter. Quantum physicists have shown clearly that objectivity is subjective. We need to develop a scientific system for clinical research that includes holistic/vitalistic parameters.

There are Chiropractors who see Philosophy as a master and this also turns our 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 who treat joint disorders to provide symptom relief care as much as it is in subluxation-based or neurologically based Chiropractors.

Many in the Chiropractic profession have lost the understanding that symptoms are signals produced when there is a failure to adapt to stress factors. In the neuro-musculo-skeletal system, symptoms are rarely the problem, with direct trauma as the main exception. Symptoms manifest an underlying problem somewhere in the system that can be readily detected when there is a correct interpretation of the physical signs and their neurological manifestations. 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 adjunctive therapeutic modalities generally becomes unnecessary.

Strict focus on the mechanical aspects of spinal function tends to eliminate the analytical information about the many neurological reflexes and expressions of functional neurology present in spinal mechanics. This mechanistic approach is characteristic of Spinal Manipulative Therapy where the principle criterion is a loss of normal motion, a fixation and/or a misalignment to a spinal joint structure independent of the functional neurology.

Early in my 44 years of clinical experience I came to realize that a vertebral fixation is put there by the body and should rarely be adjusted directly, especially if the fixation is bilateral. In its self organization capabilities, the body has put a "stop" to segmental movement for a good reason. Structurally adjusting fixations, especially those that are bilateral, constitutes a "manipulation" and is probably an act against the body's inner wisdom and may be the reason why bilateral fixations rarely hold their adjustment. 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 or adjusting the spine. In my experience, using the functional neurology inherent to the spine provides the best methodology to do this.

This may surprise many DC's, but as a general rule, Dr Henri Gillet, the founder and developer of "Motion Palpation", did not adjust spinal segments that could not move. He usually adjusted the vertebra in the direction it could move. Gillet often found that spinal fixations were often caused by fixations in the upper and lower extremities.

In his "Belgian Notes" Dr Gillet states the following:

"For many years, the fundamental aim of the Chiropractor was to replace 'vertebrae', thereby correcting one of its aspects, the malposition.

Later, the attention was attracted to the 'heat' which accompanied many subluxations, and which was supposed to constitute the pathognomonic sign of it. Others preferred the search for typical spots or areas of tenderness, or hypersensitivity, etc. There are many such signs, some of which can be brought out easily, others only with great difficulty. Unfortunately, all subluxations do not show up all of the signs in question, and it is possible that some day we will be able to classify the different types of subluxations. To choose any one sign (over others) would therefore incite the chiropractor to lose sight of all the subluxations which do not produce it (that sign)." (Clarifications added by the author)

Like many of his predecessors, Dr Gillet was keenly aware or the complexity of spinal dynamics.

In my experience, the main function of the adjustment is to restore function and to create "Ease". Ease is that experience where there is a perceptible increase in flexibility in the body accompanied by a deep sense of well being, a profound relaxation, and a sense of inner peace, which may or may not include an immediate decrease or relief of symptoms. The presence of "Ease" indicates that there is a significant restoration of normal function and is a neurological phenomenon. Curing, relieving symptoms or the treatment of joint conditions while being very helpful, usually does not create "ease" and is rarely a healing experience. Healing is more closely linked to restoration of normal function to the whole spine and has a strong neurological component.

Because stress reactions are a postural affair, the spine manifests subluxation patterns and postural changes. When we fail to adapt to these patterns of altered function we develop lower back pain, neck aches, headaches and the plethora of symptoms that become chronic and degenerative if the root cause is not addressed.

Patients receiving several weeks of corrective Chiropractic care to restore optimal spinal function, independent of symptoms, will experience profound changes in self-reported quality of life. The healing experience is characterized by profound life changes. When questioned, the patient will admit that the symptoms are usually not the problem until she is not able to lead her life in they way she would like to. Not being able to golf, walk, pick up her grandchild, sleep, feel great, or go to work, among other considerations, are important aspects of quality of life. If this quality of life is not affected, patients can and will live with symptoms for many years.

Symptoms are body signals that serve to lead us towards the understanding and identification of what is not functioning appropriately and may point to the identification of degenerative processes that may be present. Subluxations and abnormal spinal dynamics always lead to degenerations. It is only after the degenerative processes have stopped or slowed enough that the body will develop new strategies and new adaptative skills. This leads to the development of a new "normal" followed by "Wellness".

Achieving "Wellness" usually requires long-term corrective care until the maximum function is restored in the spine and nervous system. Wellness is not about feeling better. It is about having an excellent quality of life and quick recovery to life challenges. It is about being "well".

Correctly applied adjustments have been shown to 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 heart rate variability. These are some of the manifestations of "Ease". This can be easily seen by using modern biofeedback technology

A similar effect might occur if a spinal manipulation is correctly administered on an appropriate spinal segment that can positively influence the nervous system. However, in my clinical experience, this does not usually occur with the manipulation of fixations. More often, manipulations throw the central nervous system in a "fight or flight" response where alpha waves are suppressed, beta waves inappropriately increased and Galvanic Skin Response increases as the sympathetic nervous system becomes dominant. Our claim that Chiropractic care has an effect on the Central Nervous System can be shown to occur using the new Chiropractic technology now available through the use of properly configured Biofeedback instrumentation.

Neurologically based adjusting to create "ease" is the equivalent of keeping the baby while throwing out the bath water.

In our profession, it is important that we allow dogmas from any school of thought to evolve into flexible principles that allow growth, development and the mature acceptance that life is not a scientific process. Life is an expression of congruency between Philosophy, Art and Science. So is Chiropractic!

Dr Marcoux can be reached VIA email at marcouxchiropractic@shaw.ca