Just What Chiropractors Need — Another Fixation?
I think the book’s only major shortcoming is that it does not adequately address the shift underway within chiropractic toward motion palpation and the fixation concept. Many chiropractors, realizing the bankruptcy of the “bone-out-of-place,” “kink-in-the-nerve” dogma, have abandoned the classical subluxation theory in favor of the “motion paradigm.” According to this up-and-coming chiropractic theory, the bone is not “out of place” but, rather, stuck in place, unable to move throughout its normal range of motion and thus in need of mobilization. Although some chiropractors are fighting it kicking and screaming, this theory is being hailed as the profession’s ticket into the realm of science. Also, the belief that this is the right direction for chiropractic to take seems to be a growing within medicine.
I, however, think that this transition is fraught with danger — to patients. It’s a piece of cake for chiropractors to come up with misalignments, but conjuring fixations is a snap. Usually, fixations are relative. If I palpate a segment and turn the patient to the right and to the left, one side may move significantly less than the other, and I can pronounce the less mobile side “fixated.” But the body is not structurally symmetrical, and there is no reason to expect it to be functionally symmetrical. Another way to find “fixations” is to “motion palpate” several successive vertebral segments. One could declare that the segment with the shortest range of motion is fixated. But one of them had to have the least mobility.
Finding chiropractic “fixations” is even more arbitrary than finding chiropractic “subluxations.” Typically, it hinges on the intuitions, the feelings, of the chiropractor, and it might surprise you to know just how different those feelings can be. Magner did point out that “most studies have demonstrated marginal-to-poor interexaminer reliability” for motion palpation, but I would like to give a specific example. Several years ago, the Journal of Manipulative and Physiological Therapeutics (JMPT), a chiropractic publication out of National College, reported on a study of the reliability of cervical motion palpation. The test involved just one segment and the principal question was unambiguous: Did it bend better to the right or to the left? The main finding of the study was that “interexaminer agreement rates with respect to the side of greatest fixation were not found to be significantly different from that expected by chance alone, ” In other words, fixation-finding is a crap shoot. The chiropractors could not agree on whether one segment moved better to the right or to the left. In light of this, what chance is there of concordance if the field of observation is expanded to include the whole spine or the entire body? Other studies reported in JMPT and the American Journal of Chiropractic Medicine have demonstrated the interexaminer unreliability of motion palpation. Yet “life is motion” is chiropractic’s new battle cry.
There is another problem with the fixation concept: It is difficult to drum up dire consequences from it. After all, how harmful can a fixation be? As far as I know, no one has ever died from one. Restricted motion may be the only significant consequence of a joint fixation. What is the real correlation between joint fixations and symptoms? In other words, do people with joint fixations tend to have more symptoms (such as pain) than do those whose joints are more mobile? To my knowledge, no one has ever tried to answer that question scientifically. Until such a study is done, it is only an assumption that joint fixations are the cause of anyone’s pain. Inadequacy of joint mobility can be troublesome, but whether high-velocity thrusting is the best way to rectify it is highly questionable.
Rotten Apple
The last chapter of the book deals with how to reform chiropractic. Magner advocates establishment of chiropractic teaching programs within universities that teach medicine and dentistry. He proposes a new kind of degree, “Doctor of Chiropractic Medicine,” to represent the science-oriented chiropractors. He states (a) that standards should be established for the upgrading of D.C. degrees to D.C.M. degrees; (b) that D.C.M.s “should be permitted to utilize prescription drugs appropriate to the scope of their practices”; and (c) that the plan of Western States Chiropractic College (my alma mater) to start a D.C.M. program “appears to be a step in the right direction.” I think that Magner is being a Pollyanna here. I don’t think there is any way to divorce chiropractic from its historical and philosophical roots. You can’t remove subluxation theory and inanities such as “Innate Intelligence” from chiropractic and still call it “chiropractic.” Spinal manipulation has limited therapeutic utility in healthcare and can be taught and administered in nonchiropractic settings.
The chiropractic apple is rotten to the core with dogmatism and cultism. I say chuck it.
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