At first learning about the human body can be confusing at best, for the human body is a complex thing to attempt to understand.
In 2007 prominent physiotherapists published a paper on regional interdependence. This is a type of pain that occurs at a distant site to the root cause of pain (nociceptive). E.G that the thoracic spine can be the cause of neck pain, and a not so obvious one that the foot can stop head rotation short. Essentially almost any part of the body can affect any other part as we are well interconnected (hopefully!). The body in fact is bidirectional within itself (Tech bit: in a lower motor neurone way). The knee could cause the painful low back experience of an individual but does not give any pain at the knee. Regional Interdependent pain is different to referred pain as referred pain had been mapped and is known. In a case of interdependent pain the body worker assessing you would have to understand the link in order to help you with your problem. If the site of pain is treated then the problem can be made worse in the case of interdependent pain. Body workers such as chiropractors have ways of identifying areas to treat that are not pain based. Which is why some people have regular care; gaining benefit without the pain involved in a flare up.
Chiropractors are educated intellectually and trained in manual procedures differently to specialist manual physiotherapists, hence why in the case of a person with regional interdependent pain, we find that tacitly the concept is already part of chiropractic care plans to help musculoskeletal pain experiences. In other words: My pain does not always signify the body part that requires treatment. There will be an order of care in your chiropractic care plan that involves you finishing the course of treatment. Chiropractic is more than a quick click.
The spine has about 24 vertebrae with most having three joints. One joint is a disc and the other two are joints just like your finger joints that are synovial type but called facet joints. When we imbricate our facet joints of the spine as suggested by Horrigan in a condition called facet Arthrosis, pain can be generated just the same as when one stubs their finger or a toe. We all know that stubbing produces more than one type of pain because we have probably experienced it. The spine has 6 different pain mediators. Pain killers affect 2 or sometimes 3 different types of pain mediator. Meaning that pain killers have no effect on some back pain.
Imagine stubbing your finger against a wall over and over 24/7 for about two weeks. This behaviour would cause you to have a reasonably sore finger. You can stop stubbing your finger; probably because someone can point it out to you and unlike the spine you do not have to use it to move around. You have to use your spine when you move. Thus you will have a certain amount of stubbing that continues with regard to the spinal joints.
The spinal joints are surrounded by other tissues that can be pain sensitive and also be part of mixed up motor sensory signals within your nervous system. essentially a healthy joint is moving well in it’s full range of motion with synovial fluid providing nutrients in and waste product removal. A healthy joint is only part of the movement that you perform when you move. Having joint manipulation may be only part of a strategy to get you well, once again.
If you do nothing (called natural history) back pain will likely resolve in about 6 weeks. Pain killers can help to take the edge off of your symptoms during that time and you can get through it without body manipulation. Unfortunately the route of natural history can mean that your nervous system adapts to a new normal (learns to have back pain). This new normal is like updating your operating system on your computer; it is changed from the original. Once installed a new normal could return back pain as back pain is now part of your normal when you get up in the morning (load up your operating system).
Getting bodywork for a back episode helps prevent the accumulation of injuries that can occur when left to natural history. A psychological impact of (natural history) having pain in the body for over three weeks means that you become more sensitive to pain in the same area in the future. Over time you can accumulate many odd patterns of movement in a lifetime that lead you to abnormally load your tissues and send to the brain conflicting sensory motor signals. Conflicting sensory motor signals (subluxation, dysafferentation) can be the problem behind surprising bouts of back pain. The type of episodes that are really severe for a day or two and then symptomatically resolve like there was never a symptom. These conflicting messages are an indication that your sensory system could do with some help. A bodyworker provides sensory information to your brain about your body through the medium of touch (amongst other interventions). Once the right touch ‘language’ is used then your conflicting sensory motor signals conflict no more.
Chiropractic’s famous first adjustment story is recognized each year by the Chiropractic profession when we are reminded about our roots. There is much hyperbole about the story as one can imagine that occurs when embellishment meets embellishment and enthusiastic well meaning generations alter the story slightly to fit with their momentary feelings whilst retelling the story. This process repeated many times over gives a sense of mystery. The stuff every good story is made up of. For example this year the ICA have released their version of the story as:
‘On this day, 118 years ago, Dr. Daniel David Palmer administered the first specific chiropractic adjustment on his patient, Harvey Lillard in Davenport, Iowa. Dr. D.D. Palmer delivered this historic first chiropractic adjustment with the specific intent of realigning a malpositioned vertebra on the patient, restoring its normal position, and Harvey Lillard, who had lost most of his hearing 17 years earlier, noted his hearing swiftly returned under Dr. Palmer’s care.’
I personally have had two people have vast improvements in their hearing and know of 5 other chiropractic patients that have had vast improvements even two brothers under consultant supervision within the NHS who had years of tests and investigations as to their hearing deficits. The real life examples are there but few and far between to really ‘hang one’s hat on’.
Not only was the story of DD Palmer rare but a stroke of luck as described by Life University in their reconstruction of the story told by DD Palmer himself(!) http://www.youtube.com/watch?v=kSfQQGAkb7k In this telling the story is different to the intended and ‘specific’ nature of the first adjustment by DD Palmer. Here the story is that DD Palmer was saying goodbye to Harvey Lillard and on the staircase gave him a truculent slap on the back with a large book. A few days later Harvey returned to DD unannounced and said his hearing was significantly improved. Chiropractic had a chance beginning.
DD seemed to have gotten lucky and then set to work to explain what he observed. There is not mention of how many other people he tried to slap on the back with a book who had hearing problems or of his attempt to replay the context within which the slap was given. DD immediately set to work on the spine and tried to be more specific in his net application of force to Harvey. Further ‘ adjustment’ restored the rest of Harvey’s hearing (or now that Harvey was primed his expectation was to create the same state and rapport and he’d naturally get better). This is a great story and one that has set the tone of the profession from bone setting (DD had training in) into the muti technique conglomerate of done by hand that is helping millions of people get well today.
I have a particular view based upon how our practise is set up today that the first adjustment was as much about the context, meaning, intent, environment, priming and belief as much as it was the spine to ‘align’… Ever since Chiropractors have been stuck on just the spine. By using nothing more than interaction, simple props and rapport humans can help other humans over come just about anything as long as their culture and/or they think it is possible to get well (hope).
In my mind there are a myriad of explanations for why Harvey Lillard had an improvement in his hearing. DD Palmer explored many and found that adjusting the spine had a miraculous effect. Just as alcohol could fuel the first riders in the Tour De France times change, perceptions, knowledge and culture changes. Thus today the founding principles of Chiropractic cannot be held onto. They can however be kept as a comforting story about the beginnings of the largest non drug health care profession in the world. From such chance beginnings people have a way of being healthy that does not have to involve drugs. Education, knowledge and standards are changing and those for Chiropractors have changed too.
In yester year there may have been a singular adjustment that was considered the reference point that made a difference and lead to the ideas of administering an adjustment. Contemporary Chiropractors realise that the same rules do not apply today as they did one hundred and 18 years ago. The first subject may have been ‘subluxed’ at his T4 segment or his atlas (depending upon which story version you hear!) whereas today a look into the nervous system of a person may look something like:
Symptom: upper cervical pulling sensation that leads to an almost unbearable migraine that is not totally relieved with valium, pain killers and anti-inflammatories. Imaging was unremarkable.
Chiropractor interprets: Occiput dysfunction (CN10 vagus nerve), no sacral dysfunction or lower extremity dysfunction, CN9 motor dysfunction at back of throat, cn12 tongue motor dysfunction, cn11 traps weakness and opp scm (hemisphericity?), along with external ear pinna sensitivity (cn9), shimizu reflex, larger vessels in the eye, eye press dysfunction in changing heart rate; corneal reflex is ok so just cn10 dysfunction etc. Chiropractors continue along a deductive line of thought based upon the idea that somewhere the body is telling the brain the wrong information creating a Chinese whisper (subluxation) that creates an unconscious reflex response from the brain to create the sensation of a symptom. The point is that examination today is in more detail than it was in 1895 by a long way due to the advances in science and the understanding of the brain body and body brain connection.
Some chiropractors can rest on their laurels and only follow lines of possibility that are similar to the founding principle of everything comes from the spine. Even though this line of enquiry into human health was reinforced by Henry Windsor MD in 1921 for just over a decade who demonstrated that natural causes of death correlated exactly to the controlling level of the spine 99% of the time in cats dogs and humans. There have since been advances in knowledge around causes for changes in human health that are not considered a disease process. For example: development (attachment), interaction, genetics, trans-generation habits (copying conscious and unconscious aspects of influential people), environment, activation of HPA axis (trauma), culture, religion, mechanical injury, insidious injury, infectious load, fitness, family commitments, pressure of life, relationship with yourself, diet, hours driving, hours sitting, free time, spiritual development, social group, and knowledge are all factors to take into account when considering the health of a person’s nervous system.
Stories convey meaning and enable us to feel. We can all recognise a pleasant feeling over an unpleasant feeling and thus a good story from a bad. Altrusim / helping the greater good of mankind is a great theme to help Chiropractors be reminded of why they are chiropractors and not a time to return to the (original) adjustment being king and everything is from the spine! May the chiropractic profession expand, spread the modern word and help millions more people.