D.D. Palmer,The Founder of Chiropractic, gave the first chiropractic adjustment to Harvey Lillard on Sept 18,1895. Harvey owned the cleaning service that took care of the building where D.D. had a successful magnetic healing clinic. Harvey also suffered from deafness in one ear for many years. After learning that Harvey’s deafness came on after an injury to his spine, D.D. examined Harvey and found that one vertebrae was out of alignment with the rest of the spine.This coincided with the area of the spine that Harvey reported to have injured. D.D. figured that if he could restore the alignment of the spine he might be able to reverse the damage that caused Harvey’s deafness.

D.D. adjusted Harvey’s spine, he did regain his hearing, and thus began the profession of chiropractic.

Although a unique set of events aligned themselves to create the opportunity for Harvey and D.D. to meet, it was not all by accident. D.D. was in the right place at the right time to answer a question that had plagued him. As the story goes, D.D. often wondered why you can have two people that live in the same environment, breathing the same air, eating the same food and drinking the same water an done gets sick while the other doesn’t.

Ultimately he concluded that it is the internal environment that must be different from one individual to another. What controls our internal environment, our nervous system. So when D.D. adjusted Harvey he was able to start putting the pieces together. When there is stress and imbalance in the spine that affects the nervous system, this can lead to imbalance and ultimately disease in the body. D.D. never claimed to be the first person to come up with the idea of adjusting the spine to improve health, that idea goes back at least to the Egyptians.

However, he began the process of defining the science, art and philosophy of the profession we know as Chiropractic. So thank you D.D., Harvey and all the millions of chiropractors and chiropractic patients that have helped shape this great profession.

Happy Birthday Chiropractic.

“It’s not about back pain….its about your function.”

Jonas Brothers get adjusted

Check  out this article and the cover of The American Chiropractor

Besides revealing the presence or absence of proper spinal curves, side views of the spine can more easily show the long-term effects of neglected spinal trauma. We call the body’s adaptation process spinal decay.

What Causes Spinal Decay?

This process in the spine has similarities to tooth decay in that it shows up usually because of neglect. Also, just like tooth decay, it can happen to anyone, regardless of age.

Because it is often seen in older people, many believe it’s merely the normal aging process. It is not. This progressively worsening, degenerative condition is the result of uncorrected spinal misalignment. Spinal decay is how your body deals with the stress of gravity.

It just so happens that most people have spinal problems that they’ve ignored for years.

Three Phase Process

Spinal decay is a process. Whether you take three snapshots of the process or twenty-three snapshots, it’s a process. We use the three-phase model based on the book Managing Low Back Pain, by W. H. Kirkaldly-Willis and Thomas Bernard, Jr. We find that it makes the differences between each phase great enough so our practice members can appreciate what they’re seeing.

This would be considered a textbook “normal” side view of the neck.Text Book Normal

Normal

While this process can occur anywhere in the spine, it’s easiest to see in the cervical (neck) spine. This is what the side view of the neck should look like. From the side, the neck should have a graceful forward curve. The edges of each bone are well defined. There should be equal disc spacing between each bone and the openings for nerve roots should be clear and unobstructed.

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The first thing you notice is a loss of the normal cervical curve.

Phase One

In Phase One there is a loss of curve and a reduced ability to turn and bend. In some cases, the disc space between adjacent vertebrae may be reduced. Or, discs can become wedge-shaped, risking more serious soft tissue damage. Depending upon your body’s adaptive capacity, pain or other obvious symptoms may not be present. Even the resulting reduced range of motion may be too subtle for some to notice.

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Adjacent joint surfaces become rough and uneven.

Phase Two

If neglected, in Phase Two, joint surfaces lose their clearly defined edges as the early signs of bone spurs become visible on X-ray views. Some believe that the body senses the accompanying inflammation as the sign of a broken bone. It begins the process of depositing calcium salts. Without being in a cast to prevent movement, the fusion doesn’t occur. Yet.

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The affected bones have lost their individuality and ability to move.

Phase Three

If still left uncorrected, the problem worsens in Phase Three.  Amazingly, pain or other obvious symptoms may not yet show up. But finally, the body successfully “mends the broken bone.”  This process can take years.  Its presence calls into question the claim that many practice members make that they were “…fine until last week when I bent over to tie my shoes.”  That’s not what the X-rays tell us!

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The Prognosis

Some practice members who begin chiropractic care in Phase One discover a restoration of their spinal curves and improved range of motion. Success with Phase Two practice members is less predictable and depends on many factors. While we can do little after decades of neglect with Phase Three cases, we instead turn our attention to those areas of the spine that have not yet been lost to the process.

It’s impossible to predict what effect, if any, chiropractic care will have on slowing, stopping or reversing this process. Nor can a particular phase be used to predict how much care will be needed.

Doctors of Chiropractic are primary health care providers.

According to the Center for Studies in Health Policy, “The DC can provide all three levels of primary care interventions and therefore is a primary care provider, as are MDs and DOs. The doctor of chiropractic is a gatekeeper to the health care system and an independent practitioner who provides primary care services. The DC’s office is a direct access portal of entry to the full scope of service.”

Doctors of chiropractic provide effective, low-cost health care for a wide range of conditions.

Studies conducted according to the highest scientific standards and published by organizations not affiliated in any way with chiropractic institutions or associations continue to show the clinical appropriateness and effectiveness of chiropractic care. One of the most recent, funded by the Ontario Ministry of Health, stated emphatically that:”On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain…There would be highly significant cost savings if more management of low back pain was transferred from physician to chiropractors.”

Doctors of Chiropractic receive extensive, demanding professional education on par with medical doctors (MDs) and osteopaths (DOs).

To receive the doctor of chiropractic degree, candidates must complete extensive undergraduate prerequisites and four years of graduate-level instruction and internship at an accredited chiropractic institution. Comprehensive knowledge of all systems of the body and diagnostic procedures enable the DC to thoroughly evaluate a patient, address disorders relating to the spine and determine the need for referral to another health care provider.

Chiropractic is the fastest-growing and second-largest primary health care profession.

There are approximately 60,000 doctors of chiropractic (DCs) in active practice in the United States spread from rural areas to inner cities. More than 10,000 students are currently enrolled in chiropractic educational programs accredited by a federally-recognized body (CCE).

Chiropractic services are in high demand.

Tens of millions of Americans routinely opt for chiropractic services and this number is rapidly growing. In 1993, more than 30 million consumers made chiropractic a regular part of their health care program.

Doctors of Chiropractic are licensed in all 50 states.

DCs have been licensed and recognized for many decades in all states, the District of Columbia and Puerto Rico.

Chiropractic is recognized by governmental health care programs.

Chiropractic is included in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal Workers’ Compensation and all state workers’ compensation programs. Chiropractic students are qualified to receive federal student loan assistance and DCs are authorized to be commissioned as health care officers in the U.S. Armed Forces.

The practice of chiropractic is based on sound scientific principles.

The existence of the nervous system as the primary control mechanism of the body is an undisputed scientific fact. Its relationship with the spine is the focus of the practice of chiropractic. The spine develops in utero to provide two primary functions: (1) allow for freedom of movement and (2) house and protect the spinal cord. When the vertebrae of the spine become misaligned through trauma or repetitive injury, two major consequences will result: (1) the range of motion becomes limited and (2) spinal nerves emerging from the spinal cord are compromised. DCs use the term “subluxation” to describe such disruptions. Interruption of nerve flow can eventually lead to pain, disability, and an overall decrease in the quality of life. Conversely, the removal of that interference has been shown to have significant, lasting health benefits. Through the adjustment of the subluxation, the doctor of chiropractic endeavors to restore normal nerve expression. The body is then able to respond appropriately to any imbalance in the system, thus relieving symptoms and restoring health.

The doctor of chiropractic is an effective source of preventative and wellness care.

The anatomical focus of the DC on the human spine has created the perception of the DC as just a “back doctor.” Although this perception is not entirely incorrect, it is very much incomplete. Doctors of chiropractic are a highly appropriate resource in matters of work-place safety, stress management, injury prevention, postural correction and nutritional counseling.”

The process of chiropractic adjusment is a safe, efficient procedure which is performed nearly one million times every working day in the United States.

There is a singular lack of actuarial data that would justify concluding that chiropractic care is in any way harmful or dangerous. Chiropractic care is non-invasive, therefore, the body’s response to chiropractic care is far more predictable than its reactions to drug treatments or surgical procedures. Of the nearly one million adjustments given every day in this country, complications are exceedingly rare. Perhaps the best summary statement on the subject of safety was published in 1979 by the Government of New Zealand which established a special commission to study chiropractic. They found:

“The conspicuous lack of evidence that chiropractors cause harm or allow harm to occur through neglect of medical referral can be taken to mean only one thing: that chiropractors have on the whole an impressive safety record.”

Age
A significant increase in back pain incidence occurred at the age of 12 years and over. In all age groups above 11 years, more than 50 percent of the subjects had experienced back pain at some time in their life.

Gender
Females were more likely to experience back pain than males. A significant increase in back pain incidence in females was noted at 58.1 percent, compared with 43.2 percent for males.

TV
Children who watched television for extended periods were more likely to have back pain. Of those children who watched TV between 1-2 hours each day, 59.3 percent had experienced back pain. When the viewing time was increased to more than two hours each day, the incidence of back pain increased to 68.8 percent.

Sports
The prevalence of back pain associated with sports was calculated and found to exceed 60 percent for participants of the following sports: volleyball (78.2 percent); climbing (68.7 percent); golf (64.8 percent); basketball (62.6 percent); and handball (61.7 percent).

Previous Back Injury
For children who had previously experienced back pain, there was a significant risk identified for future occurrence. Trousler’s study also identified that 41.6 percent of the participants experienced back pain while sitting in class; 30 percent within one hour, and 70 percent after sitting for longer than one hour. On the issue of satchel carrying position, 68.6 percent of children had back pain when they carried their satchels by hand, compared with 53.7 percent who carried their satchels on the shoulder, and 45 percent when carried on their back. The specific incidence of location of back pain was identified as being lumbar 41 percent, thoracic 34 percent and cervical 26.5 percent.

Other studies have examined body size and flexibility as possible precursors to back pain in children.

Nissinen studied anthropometric measurements and the incidence of low back pain in a group of 1,060 children, and concluded that sitting height and trunk asymmetry appeared to contribute to low back pain.

Ebrall, in a study of adolescent males, concluded that upper body size significantly influenced the prevalence of back pain, as did pelvic height.

In a controlled study of 1,503 children, all 15 years of age, Salminen concluded that:
- males who had recurrent or continual low back pain were over 4 cm taller than controls, – in both sexes of those who had back pain, lumbar extension and straight leg raising was decreased, while lumbar flexion was increased, and – endurance strength in abdominal and back muscles, in those who experienced back pain, was decreased relative to the control group.
Kujala studied 100 athletes and 38 non-athletes and concluded that prevalence of low back pain in the athletes could be correlated only with tightness of the hip flexor muscles. The study suggested that high training duration predisposes young athletes to low back pain. Olsen, studying the epidemiology of low back pain in an adolescent population of 1,242 subjects identified that one third of the subjects had restricted activities due to low back pain and that 7.3 percent required medical attention.

Salminen, in a study of 1,503 school children, aged 14 years, found that low back pain was the third most common form of pain interfering with school work and leisure activities. Of the children who experienced back pain, 65 percent recovered within one month and 35 percent reported disabling low back pain and were aware of recurrent or continual pain.

Miereau and Cassidy studied 402 subjects 6-18 years old and identified a significant direct relationship between history of low back pain and decreased straight leg raising in adolescent males.

In studying female gymnasts, Olsen identified that subjects with low back pain had significantly larger lumbar lordosis (41 degrees) than in those with no history of low back pain (35 degrees).

Balague, studying 1,715 school children of both sexes, identified significant positive correlation between low back pain and age, female sex, time spent watching TV, smoking and competitive sports.

Back pain is a major problem which afflicts about 80 percent of the population. Prevalence studies in children have reported incidence rates varying between 7 and 51 percent. Although the methodology, age range and criteria for back pain has varied widely in these studies, there appears one strong theme: that back pain in children is a major public health issue. Further studies must be conducted to evaluate not only epidemiology, but also to evaluate treatment protocols and preventive measures for children with back pain.

References

Balague F et al. Cross-sectional study of isokinetic muscle trunk strength among school children, Spine, July 1993, Vol 18(9), 1199-1205.
Balague F et al. Low-back pain in school children: An epidemiological study. Scandinavian Journal of Rehabilitative Medicine, 1988, Vol 20, 175-179.
Ebrall P. Some anthropometric dimensions of male adolescents with idiopathic low-back pain. Journal of Manipulative and Physiological Therapeutics, June 1994, Vol 17(5), 296-301.
Kujala U et al. Subject characteristics and low-back pain in young athletes and non-athletes. Medicine and Science in Sports and Exercise, June 1992, Vol 24(6), 627-632.
Miereau D et al. Low-back pain and straight leg raising in children and adolescents, Spine 1989, Vol 14(5), 526-528.
Nissinen M et al. Anthropometric measurements and the incidence of low back pain in a cohort of pubertal children, Spine, June 1994, Vol 19 (12), 1367-70.
Olsen T et al. The epidemiology of low-back pain in an adolescent population. American Journal of Emergency Medicine, May 1994, Vol 12(3), 334-336.
Olsen G et al. Spinal sagittal configuration and mobility related to low back-pain in the female gymnast. Spine, 1989, Vol 14, 847-850.
Salminen J et al. Spinal mobility and trunk muscle strength in 15 year-old school children with and without low-back pain. Spine, April 1992, Vol 17(4), 405-411.
Salminen J et al. Low-back pain and disability in 14-year-old school children. Acta Paediatrica Scandinavica, Dec 1992, Vol 81(12), 1035-9.
Troussler B et al. Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitative Medicine, 1994, Vol 26, 143-146.
Peter Fysh, DC
San Jose, California