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This may seem to be a biased chapter in the book, but after I
explain some foundational elements and try to clear up many wrong
concepts, I think you will understand why I've included it. How
does one begin to address this controversial area of health care?
Chiropractic began in 1895 in Davenport, Iowa, and ever since
has been fighting for its life. From being branded as quacks to
being thrown in jail, doctors who practiced Chiropractic have
obviously believed in the validity of what they did. Having gone
to school for a degree as a Doctor of Chiropractic, I can attest
to that belief.
I will have to say I have never lived in a more exciting time
period for Chiropractic than what is occurring these days. With
the victory in the antitrust suit against the AMA and other
groups,1 the Rand study,2 the positive articles in Time, 3 and
other publications, the 20/20 news program taping, Chiropractic
is gaining credibility in the primary health care arena.
Any profession could not possibly survive for almost 100 years
without there being something to it. And Chiropractic has not
only survived, but it has grown and is presently the largest,
drugless healing art in the world. Why, you might ask? Let me
try to explain.
The human body is composed of billions of cells which combine
to form many differing tissues, which combine to form organs and
systems. Systems such as the circulatory system, the digestive
system, the skeletal system, the lymphatic system, the respiratory
system and the nervous system play important rolls in our day
to day living. The focus for this discussion will be on two specific
systems, the skeletal system, primarily the spine, and the nervous
system, though there is a relationship between all of the systems.
The human spine consists of 24 movable bony segments called vertebra.
Each vertebra has a set of joints, two on the top and two on the
bottom which join to the vertebra above and below. It is these
joints which provide the ability to move in various directions.
Bending and twisting are possible because of the simple, essentially
flat, but vertical--that is up and down nature of the spinal joints.
These joints glide on one another, and with a lubricating fluid
between them, provide for a wide range of flexibility. Ligaments,
the strong tight band of tissue we discussed earlier, form a protective
capsule which holds the joints together and provide limitations
in motion which protect the joints. It is these joints which go
"pop" when a Chiropractic adjustment is given. More
about THAT a little later.
Between all but 1 of these vertebra there are cushions know as
intervertebral disks. These disks act as shock absorbers between
the vertebra and maintain a distance between the vertebra, which
in turn supports the vertebral joint structures at an optimum
level with each other for best mechanical functioning of our backs.
The closer these joints come to each other, the less mechanical
range of motion there can be. These disks are therefore important
in the ability to move.
These disks are composed of a jelly-like substance which is inside
a tough coat. This donut like structure is attached to each vertebra
at the top and at the bottom, as well as becoming a part of a
tough band of material called ligaments which entirely cover the
front and back portions of the vertebra and disks. The disks do
NOT have a direct blood supply of there own and therefore depend
on another method to receive nourishment. That method is MOVEMENT.
It is the motion which the spine goes through that maintains a
pressure gradient that helps to draw in nutrients and water to
maintain the pressure inside the disk and to nourish the cells,
and to provide for healing.
As we move, bend and twist, these disks flex because of the jelly
like nature of the inside and help to distribute the weight load
evenly up and down the spine, and maintain the relationship of
the vertebral joints. It is these structures which are involved
when you hear the term, "slipped disc," although the
disc can't possibly "slip" anywhere, as my description
of the ligaments which entirely surround the spinal structure
showed. The term slipped disc is a cheap term coined by doctors
to satisfy patients about their condition without having to explain
Slipped discs are in reality, discs whose outer, tough coat has
been injured, usually over a course of years through the micro-trauma
of minute degenerative changes mentioned earlier, or from accumulated
trauma of improper work habits or repetitive work stress. This
tearing of the outer coat allows the inner "gel" to
ooze out and place pressure on the nerve which is in the vicinity.
Needless to say, this pressure can cause excruciating pain. The
surgical answer for this removes the extruding piece, relieving
The Chiropractic approach is to prevent the rupture from happening
in the first place and/or by working with the joints and discs
to take the abnormal pressure off of the outer coat, thereby relieving
the inner pressure. More will be discussed about this a little
THE NERVOUS SYSTEM
With the vertebra described, we can next look at the relationship
between the vertebra and the nervous system. The skull houses
the brain from which the spinal cord runs. The spinal cord carries
information from the brain, down through the vertebra and out
little holes called foramen which are formed by the coming together
of two vertebra. From here the nerves travel throughout the entire
body and either directly or indirectly influence every aspect
of our physiology by way of the information which the brain sends
As long as there is a proper channel of communication between
the brain and the rest of the body, the corresponding organs and
tissues "know" how to function, by itself and in conjunction
with how the other systems are functioning. This degree of communication
is absolutely necessary for optimum performance of any system.
Should there be an interference with that flow of information,
there will be a corresponding decrease in the proper performance
of the area affected by the interference.
Naturally, because many of you have had experience with the Chiropractic
profession, you are somewhat familiar with the term "pinched
nerve." You have been told that a pinched nerve is what you
have when you have pain in your neck or back. The technical term
often used has been called a "subluxation." Most people
know what a "dislocation" is. A joint which has been
forced out of place. Well a "subluxation" was coined
to describe what to describe what was occurring with the joints
of the spine. The joints somehow were affected, causing them to
be moved "out of place," but to a much LESS degree than
an actual dislocation.
We believe this subluxation to be the culprit behind the actual
nervous system involvement. Obviously, if someone were having
some degree of trouble with a particular organ or system, it was
a logical assumption that it was possible for it to be due, in
part at least, to some degree of nervous system involvement. Research
to date has shown conclusively that pressure on the spinal nerves
does indeed cause a change in that nerve's ability to transmit
information along its course.5 If you have ever hit a nerve in
your own body, such as your "funny bone," you will readily
agree that something indeed occurred which you often felt along
the entire course of the nerve. In the beginning the nerve of
nerve pressure, the nerve is extremely sensitive and will become
swollen, often leading to further limitations of the motion which
places pressure on the nerve. After prolonged pressure, atrophy--(shrinking)
of the nerve will take place, and thus the communication which
the brain sends through the nerve to various tissues such as the
heart, stomach, muscles, etc., can be interfered with. An analogy
might help. If you've ever used a garden hose to water your lawn
or garden, you can readily understand what happens when someone
steps on the hose, or a car drives onto the hose. The water flow
is decreased. The physiology involved within the human body is
far more detailed and complicated, but the analogy is valid.
In actual fact, there is most likely an intricate combination
of nervous system, lymphatics, brain, circulation, emotions, joint
mechanics and who knows what else going on with the spine at any
given moment. There is a lot of research that needs to be done
to provide better understanding as to WHY and HOW problems develop
and adjustments and other steps help. One important issue to remember
is that, in most cases of back pain and discomfort, the pain is
due to muscle involvement and not a "pinched nerve."
The concept of, "My backs out," though, is at best inaccurate,
and at worst, a hazardous approach concept to base your health
THE "BONE OUT OF PLACE" MYTH
This brings us to the most common concept people have concerning
Chiropractic and their backs. It must be added that our own profession
has propagated this concept, largely due to antiquated concepts
developed in the early years of Chiropractic growth. Today we
have a great deal more technology, and can somewhat better understand
just what is going on with the spine . Chiropractic has, for as
long as I can remember, held to the bone out of place concept
to explain the mechanisms behind Chiropractic. When someone's
back was "out", wherever that is, they were taught to
believe that they needed to have it put back "in." This
approach has unwittingly propagated in the minds of the public
the false concept that spinal pain and symptoms indicated a "bone
out of place", and NO spinal symptoms meant there were no
problems. Remember we discussed the concept of pain and no pain
earlier? The instant cure, magic bullet approach to health persists,
even in natural health care.
If we look at this concept logically, we HAVE to realize that
if "in and out" were a valid concept, considering the
anatomical structuring of spinal joints as explained above, then
the simple mechanical movements of bending and twisting would
have to be continuously moving the joints "in and out of
place." That is an area of contention which the medical profession
has had for years. They simply looked at the spine and scratched
their heads wondering HOW we could view the anatomical structure
of spinal joints as even being constructed in such a way as for
them to be "in" or "out." That has made it
difficult for the two professions to work together.
So let's forget the common phrase, "my back or neck is out"
and focus on the reality of what is going on. The human body was
designed for use. Any aspect of the body NOT used on a regular
basis will soon undergo what is called disuse atrophy or disuse
degeneration. It is a natural result of improper use or inadequate
use of any given part. As with any changes the body undergoes,
disuse degeneration occurs over time, as we've already discussed.
It isn't something we can feel or notice outwardly such as pain.
Only until the tissues involved reach "the limitations of
matter" do symptoms usually present themselves. By then years
have gone by. Let's go over some more physiology and how this
relates to Chiropractic, and for that matter, most of our everyday
DEGENERATION AND HUMAN PHYSIOLOGY
In the chapter on NATURAL LAW, we mentioned how human physiology,
(all life for that matter) has a specific, personal rate of degeneration.
This rate is controlled by many different factors including, genetics,
environment, social stresses, nutrition, fitness, emotional elements
and time. The "nature" of nature is such that, if left
to itself it will NOT perform as well as if there is a positive
intervention into the processes which control and direct things.
If left to natural processes, there will be an accelerated rate
of decay and degeneration in the non-living physical things like
our cars, etc., unless steps are taken to MINIMIZE these changes
through such things as oil changes. As for living things, there
is a degenerative rate occurring, but during the lifetime, there
is a degree of productivity that is fairly steady, UNLESS specifically
intervened in. Our personal level of physiological potential,
that is, our potential for good health in the physical world,
essentially predetermines our MINIMUM level or rate of degeneration.
If our behavior in interacting with the world is not in keeping
with the overall natural system, then we can actually begin to
MAXIMIZE that genetic and physiological rate of degeneration.
This can occur through the areas previously mentioned. If our
nutrition complies with the boundaries set by natural law, then
can be assured that we are doing all we can in this area to maximize
our physical life potential. If the environment we live in is
polluted and we breath foul air, drink toxic water, and live or
work under toxic conditions, then we are, again, placing ourselves
in an accelerated physiological mode. Emotional elements, social
stresses, lack of exercise and other areas also contribute to
How does all this fit Chiropractic? Think about it. If the human
body has a natural physiological rate of degeneration under day
to day "modern" activity, which it does, doesn't it
seem logical that intervening to minimize those affects and working
WITH the bodies physiological processes, we could prolong the
otherwise normal outcome? Spinal mechanics and joint action are
hinged on one primary element. MOTION. Why is movement so important?
Take what we know of motion. Motion affects circulation by the
contraction and relaxation of the muscles responsible for the
movement. In fact, contrary to what many may believe, the circulation
is greatly enhanced by muscular activity and motion. It forces
blood, which carries oxygen and nutrients, throughout the tissues
and augments the removal of metabolic and degenerative waste products.
The implication here is that to the degree that movement is limited,
there will be a corresponding decrease in the health of the tissue
environment. This leads to toxin buildup and increases the rate
of degeneration of the area. Movement also stimulates the nervous
system, stimulates tissue healing and regeneration, maintains
tissue strength and functional integrity, etc.
Mechanically speaking, improper motion affects not only local
joint and tissue physiology, but also the mechanics of more distant
joints and thus, that area's physiology, and ultimately, the functional
integrity of the whole system is compromised. The vertebra function
as a UNIT. Each bend we make is involving many of the vertebra,
each contributing its own little amount of movement. These small
amounts of motion add up to the full flexibility we can normally
achieve. If there is a problem with the mechanical ability for
one vertebra to freely go through its range of motion, then the
motion or transfer of stress and work which should be accomplished
by it does not occur.
In fact, this derangement in the movement actually increases
the stress on that particular joint. It also creates an abnormal
mechanical roadblock to proper activity of other parts of the
spine and back. If left unattended, this will lead to conditions
such as degenerative joint disease and disk degeneration. As these
areas become more and more involved, nervous system communication
problems develop, which in turn affects our internal organs to
the point /that they can no longer operate as directed by the
Add to loss of motion, this element of spinal injury, and we
have set up a scenario for this slow degenerative process to take
place with similar results. When we are injured in a car accident,
have a fall or mishap, we actually tear tissue on the inside of
our body, primarily muscle and ligament tissue around such things
as joints. Muscle tissue is torn and blood vessels rupture. This
allows a pool of blood to form which provides an excellent medium
for cell growth and tissue healing. The problem with this normal
physiology is that this pool of blood isn't picky where it runs.
Wherever the blood leaks is where the cells will grow. The death
of tissue within the body leads to scar tissue formation, the
same as when you cut yourself on the outside. This scar tissue
isn't elastic, just as a cut heals with scar tissue on the outside,
so too do the injuries on the inside heal with scar tissue. In
spinal injuries, the tearing of tissue causes bleeding. This bleeding,
if unchecked or untreated, leads to a pool of blood in which cells
grow and scar tissue develops in order to close up and secure
the injury. If this occurs around any area of normal motion, then
the scar tissue can interfere with this motion.
As this scar tissue reaches full maturity, it creates a restriction
in the area it involves. Scar tissue is non-elastic. That is,
it does not stretch and flex as other normal tissues do. If a
joint is injured, this scar tissue will have formed around or
IN the joint itself. You can see how this could create mechanical
dysfunction. As motion is impaired, the above scenario of circulation,
oxygen and nutrition comes into play. The degree of scar tissue
development corresponds to the amount of tissue damage. A bigger
factor and much more serious factor in these kinds of injuries
is to what degree there has been intervention on the injuries.
If any injury is allowed to progress on its own, without some
degree of treatment, it almost unfailingly leads to premature
degenerative changes, and often permanent injury. Even WITH proper
treatment, areas of injury often are the first area we notice
problems with as we get older.
What happens when movement is altered, tissues are injured and
there is no intervention? What happens when the above mentioned
physiological processes are hampered? Degenerative change! Isn't
it reasonable to conclude that the loss in any of the above mentioned
normal processes of motion and physiology would INCREASE the physiological
rate of degeneration? All of these physiological factors add up
in different ways.
Consider arthritis for a moment. Looking at physiology as we
understand it, could there be a correlation between lack of motion
and tissue degeneration, poor oxygen supply, waste product buildup
and poor nutrition? "Disuse degeneration!" As we get
older we become less active. Activity--MOTION--maintains tissue
integrity and minimizes that degenerative rate. The old saying
"Use it or lose it" is a vital concept to keep in mind.
It isn't necessarily old age which brings on arthritis. It is
the gradual decrease in activity as age progresses. This decrease
promotes the changes we have been talking about.
What about muscle spasms? Lack of motion or proper motion at
work, chronic stress, or repetitive motions can all contribute
to microscopic degenerative changes which, on a chronic or long
standing basis, are responsible for the tissue damage, joint involvement,
spasms, fascial irritation, adhesions (tissues sticking to other
tissues), chronic pain and neurological involvement which frequent
such problems. There is a cause and affect system working within
each of us. Weaknesses we may have and predisposition to diseases
such as cancer can be affected by the degree, or lack thereof,
of minimizing negative physiological processes.
WHAT DOES CHIROPRACTIC DO?
Look at normal body physiology. The simple aspect of immobilization
on any part of the body is understood to be, what I term, "a
negative physiological accelerator," (others being poor nutrition,
unhealthy environment, genetic weakness, high stress levels, emotions...)
which accelerate the rate of degenerative change. An arm or leg
in a cast always exhibits atrophy, (muscle wasting), weakness
and joint stiffness. ALL are aspects of degeneration. These changes
occur over the course of 6-10 weeks. If allowed to continue longer,
the area would become dysfunctional.
Take this understanding and apply it to YOUR daily life. If asked,
most of us could show a moderate range of motion--twisting, turning,
bending. Ask yourself, "How often do I regularly use my spine
in such a way?" "How often do I put my back and body
through those FULL ranges of motion?" Not doing so will,
over time, lead to the conditions I've already explained. Remembering
the injury element also and you can see how easily our spines
can become adversely involved.
Enter the Chiropractic "adjustment." Rather than "putting
backs into place," the adjustment is restoring proper joint
and spinal mechanics. That is, MOVEMENT is being restored to a
spinal segment or segments which, for whatever reason, has become
fixated, (stuck) in its ability to freely move. Perhaps a better
and more clear concept is "FIXATION subluxation." The
adjustment places specific motion into a specific joint. Depending
on the degree of immobility, and remembering that it can take
years for such conditions to reach the symptomatic threshold,
it will logically take some time and work to restore proper mechanics
to the spine. Trying to decrease scar tissue buildup and stretch
out what remains is not as simple as "putting a bone back
in place." As the spine becomes more and more involved, affecting
more and more joints, there can be spinal deviation as a whole
unit. The forces of gravity, stress and the work we do all act
to "shape" the weakened and mechanically dysfunctional
spine. This shaping occurs over time, such as with spinal scoliosis--the
sideways bending of the spine, or postural deformities. It is
impossible to simple move bones and restore mechanical functioning
by "popping a back."
Correcting such problems, which usually develop over the course
of years, takes its own time. That is the reason for the series
of treatments which include adjusting the joints, as well as,
and just as important, therapy with ultrasound6 and other helps.
It is often assumed that the quick fix is all that is necessary
for correcting spinal problems. An analogy will help here. I mentioned
before how a dentist has to work with ligaments in the repositioning
of teeth. That same tissue is closely adhered to the spine. We
all know that braces aren't something which one wears for only
a week or two. It can take years for such corrections to take
place. You don't go in for tightening of the wires and then have
the braces taken off. Neither will going in for a few adjustments
alleviate years of spinal problems.
Anyone with any experience with the Chiropractic profession may
be wondering why they got such quick results from a few adjustments.
I once had a patient who had migraines for 20 years of her adult
life. After one adjustment, the headaches were gone. Even I was
surprised. She promptly stopped treatments only to return several
weeks later because they returned.
The reason she, and others can experience such immediate relief,
or even relief within a week or two is simple to understand. Imagine
the process leading up to the eventual loss of joint motion, called
a fixation, that we've already described. Muscles spasm, the joint
is "stuck or jammed." All these lead to the development
of pain and discomfort. Everyday motion and activity are funneled
through the spinal joints and musculature. The affects of gravity,
stresses of motion, mechanics, etc., all are absorbed and "equalized
throughout the spine. If there is an area where this "equalization
of stress" can't occur, you get a specific point of pain
where the pressure or stress is "caught" and it builds
up, eventually, to the symptomatic level.
When an adjustment is given, this pressure is released and some
degree of motion is restored to the particular area, thereby,
in some cases, relieving the symptoms entirely. It is easy to
understand how this relief could be taken to mean "cure."
However, it is far from that. It is merely the first few steps
in a process which takes time and consistent effort to repair.
Once correction has reached its limitations, which is generally
the same for most people,7 then it is important to view your relationship
with your spine as a Preventive AND MAINTENANCE relationship.
As we have mentioned before, in order for nature to function optimally
for our benefit, it requires some degree of action or INTERACTION
to bring about the positive results.
Just as we change the oil in our cars, tune them up, maintain
other equipment or even our pets. Without regular maintenance,
there will be an increase in the physiological degeneration, or
in the case of cars, an increase in the wear and tear and a decrease
in the life expectancy. We are no different. It takes constant
work to maintain our bodies. Try eating as often as you exercise.
Try sleeping as often as you eat wholesome, REAL food. Get the
idea? Health ISN'T a vitamin, a weight machine, a sport program,
a drug, or an adjustment. It IS a way of living. A process, a
journey. It is an active thing which has to be continuously supported
by the right system of procedures. Health, good or bad, is the
result of an accumulation of either positive or negative physiological
support. WE and only WE can set up and make as a part of our daily
life the right support system for these machines we are. Unless
we take this responsibility upon OURSELVES, we can expect less
chance for a much more rewarding and healthy lifestyle.
I would be remiss if I failed to discuss the important issue
of nerves and spinal problems. The entire premise of Chiropractic
has been based on the relationship between spinal joints and spinal
nerves. Any point along the cycle of spinal problems, from day
one, to a 20 year problem, there is a very real and yet not readily
understood even taking place which affects all of us at one time
Regardless of at what point it may occur, spinal nerves can and
do become involved in the complex scenario taking place within
the tissues. As the degenerative changes take place, there is
also a corresponding level of interference potential that can
take place with the associated nerve which exits the spine. Depending
on which tissues or organ this nerve happens to "control,"
there can be corresponding degrees of malfunction taking place.
For instance, if the nerve to the stomach is being disturbed,
keeping in mind our discussion on the steps a nerve goes through
when compressed or irritated, there can be a higher level of stomach
acid production. Prolonged overproduction of stomach acids can
lead to tissue destruction within the stomach walls, known as
an ulcer. Let this problem develop into a chronic, long lasting,
yet low level nerve interference, and you could have problems
digesting at all.
This example can apply to any organ or tissue in the body. Muscles,
reflexes, senses, skin, you name it. I do not participate in the
school of thought held by some doctors of Chiropractic that all
disease is a result of nerve and spinal problems. I CAN say, however,
that can be a factor in the overall health status of many of us.
It is, as I've said many times before, another piece of the health
picture, one we shouldn't ignore.
Report written by Dr. Jeffrey T. Maehr, D.C. (Ret.)
Copyright © 1998, All rights reserved.