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 the problem.
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 pressure.
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 later.
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 through them.
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 upon.
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 activities.
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 the problem.
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 brain.
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 or another.
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.