Talk:Spinal adjustment

"Adjustment" does not equal "manipulation"

This article on "adjustments" needs to be kept separate from medical spinal "manipulation" (as performed by MDs, PTs, and DOs), because chiropractic adjustments are performed for a specific philosophical (and metaphysical) reason which is not recognized by medical science. Chiropractors perform "adjustments" to correct subluxations (not recognized to exist by medical science). This is the legal basis for chiropractic reimbursement under Medicare:

• "manual manipulation of the spine to correct a subluxation" [1]

While the actual physical action and effect of an adjustment and a manipulation may be identical (in the eyes of an MD, PT, or DO), DCs like to make the artificial distinction that they are the only ones that can "adjust", while all others can "only" manipulate.

Philosophically speaking (from a DC's viewpoint), this is true, since a chiropractic "adjustment" is for the purpose of "correcting a subluxation". This is a purely chiropractic delusion. This delusion has been perpetuated by it being made the legal umbrella under which DCs work.

A manipulation by an MD, PT or DO, on the other hand, is not performed for the purpose of correcting a non-existent entity. Therefore it certainly does not, and never should, get any priority or legal status as a method for the "correction of subluxations"!

DCs (usually young, newly educated ones) who derogatorily speak of other's ability to "only manipulate", are guilty of at least two faults: (1) they overrate the usefulness of "adjustments"; and (2) they reveal their ignorance of what other professions can do, why they do it, and especially, when and why they DON'T do it.

The "service" of manipulation of the spine "to correct a subluxation" is a service that only DCs claim to provide. PTs & MDs can not and will not contribute to this deception. It is also an unnecessary extra expense and risk for taxpayers, insurance companies and patients. The wording, "to correct a subluxation", should be removed and replaced with some real diagnoses, for which spinal manipulation can be helpful as a part of legitimate, scientific therapy.

The artificial distinction between "adjust" and "manipulate" is not consistently upheld by DCs. The term "manipulation" is often used by them. The reason for this ambiguity lies in something more than the words. In reality, they would like to eliminate any other profession's right to "manipulate" or "adjust", call it what you will, for whatever purpose. Exclusivity is the issue. They want a patent on the use of all manipulative techniques, especially HVLA.

-- Fyslee 20:13, 21 January 2006 (UTC)

Proposed change to definition:addition of effects, side effects and benefits

This definition can be greatly improved by adding a discussion of controversy, types of treastments, effects and side effects. I have edited and supplemented the existing text and propose the following:

"Spinal adjustment is a term used by chiropractors to describe any of a number of specialized spinal manipulations which are claimed to improve the alignment and/or motion of painful spinal and extremity joints. The procedures make up the mainstay of chiropractic treatment, but may be supplemented with exercise, electrical modalities and nutritional recommendations.

Many chiropractors believe that spinal adjustment is different from the spinal manipulation performed by physical therapists and osteopaths because the latter never try to improve vertebral alignment when performing manipulations. Despite the different treatment goals, the actual procedures performed are very similar. Further, any distinction is questionable because of evidence refuting the claim that adjustments reliably restore misalignments (called subluxations by chiropractors).

The most common “adjustment” employed by chiropractors is a high velocity, low amplitude (HVLA) thrust that usually causes an audible popping sound that results from nitrogen gas being released from the synovial fluid found in diarthrodial joints. When an adjustment is performed by a chiropractor, the force applied separates the joint surfaces of the fully encapsulated joint creating a relative vacuum within the joint space. In this low pressure environment, the naturally dissolved nitrogen found in all bodily fluids turns into a gas and a sound is heard. This gas bubble will remain within the joint for hours while it is slowly reabsorbed by the body. The effects of this treatment include: temporary relief of musculoskeletal pain, shortened time to recover from acute back sprains and reduction of muscle spasm. Soreness from minor, treatment induced joint strains, dependency on treatment and neck hypermobility are common side effects. Less frequent but more serious side effects include: stroke, herniation of intervertebral disks and rib fractures.

Other types of adjustments may include thrusts from mechanical instruments, dropping tables and gentle sustained touches. Most involve elaborate analyses and questionable biomechanical rationales." Abotnick 23:07, 16 February 2006

Needs correction

This paragraph contains an inaccuracy:

Spinal adjustment is a term used by chiropractors to describe any of a number of specialized spinal manipulations which are claimed to improve the alignment and/or motion of painful spinal and extremity joints. The procedures make up the mainstay of chiropractic treatment, but may be supplemented with exercise, electrical modalities and nutritional recommendations.

The problem is with the word "painful." Especially in connection with "maintenance" or "wellness" care, adjustments are often given for non painful and asymptomatic vertebral subluxations. Insurance companies specifically write in their policies that they will not pay for these adjustments. Both of these aspects need to be incorporated in the paragraph or article. -- Fyslee 23:33, 17 February 2006

Painful change

Further clarification needs to be made regarding restoration of the word painful in your change. A major diagnostic criteria for subluxation is tenderness on palpation. This should be considered a type of pain. I am not aware of one chiropractic technique that does not require it. Therefore I suggest we restore the word painful to that sentence.

"Spinal adjustment is a term used by chiropractors to describe any of a number of specialized spinal manipulations which are claimed to improve the alignment and/or motion of painful spinal and extremity joints." Abotnick 15:21, 18 February 2006

Okay.....you must be talking about an ideal, while I'm talking about reality.

If pain is a diagnostic criteria, why do so many chiropractors "adjust" asymptomatic joints, IOW joints without pain, dysfunction, or any other symptoms? There is often no objective measure for the location of these subluxations. Only the chiropractor seems to "know" and "decide" where these "subluxations" are located (and no two chiros can agree on where), and convinces the usually well "educated" customer to accept this interpretation, and thus the supposed necessity of the adjustment. Since a manipulation often produces a temporary sense of comfort, combined with a very strong placebo "pop," the customer is convinced that the chiro's explanation - that he has "pushed it back into place" - must be correct.

That is often the reality of chiropractic practice, especially for "wellness" chiros. Their "practice members" (patients) have been so well "educated" (indoctrinated) that they willingly and eagerly return for regular adjustments in the complete absence of any symptoms, or other indication that treatment is necessary. This is also why more and more DCs are turning to cash practice, since insurance companies expressly refuse to pay for such scam treatments. -- Fyslee 18:07, 18 February 2006 (UTC)

Just to make it clear that I realize there is more to chiropractic than what's described above, I should state here that there are of course chiros who use manipulation in much the same way I could do it, which is as a legitimate (except in the neck) part of treatment, where there are clear symptoms of pain and stiffness. Now I actually usually prefer using other methods, but it is an option I could, and occasionally do, choose. -- Fyslee 18:50, 18 February 2006 (UTC)

Okay.....you must be talking about an ideal, while I'm talking about reality.

I got to the bottom of this. You are right, pain isn't mandatory-I thought it was. The following reference only requires two diagnostic criteria and pain isn't mandatory. Thanks for challenging me on this.

[qoute]Demonstrated by Physical Examination.-- Evaluation of musculoskeletal/ nervous system to identify:

· Pain/tenderness evaluated in terms of location, quality, and intensity;

· Asymmetry/misalignment identified on a sectional or segmental level;

· Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); and

· Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament.

To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under "physical examination" are required, one of which must be asymmetry/misalignment or range of motion abnormality. [/quote]

http://www.cosvi.com/medicare/services.asp?service=159

>:If pain is a diagnostic criteria, why do so many chiropractors "adjust" asymptomatic joints, IOW joints without pain, dysfunction, or any other symptoms? There is often no objective measure for the location of these subluxations. Only the chiropractor seems to "know" and "decide" where these "subluxations" are located (and no two chiros can agree on where), and convinces the usually well "educated" customer to accept this interpretation, and thus the supposed necessity of the adjustment. Since a manipulation often produces a temporary sense of comfort, combined with a very strong placebo "pop," the customer is convinced that the chiro's explanation - that he has "pushed it back into place" - must be correct.

I've seen chiros routinely adjust tender nonpainful joints but never totally asymptomatic ones.

.

This is what Rand says "RAND researchers used the same analytical approach to evaluate treatment of the neck for neck pain and headache. They looked at studies that evaluated mobilization and physical therapy as well as manipulation. Their findings: (1) mobilization--but not manipulation or physical therapy--probably provides at least short-term relief from acute neck pain; (2) manipulation is probably slightly better than mobilization and physical therapy for subacute (3 to 13 weeks' duration) or chronic neck pain, and all three treatments are probably better than standard medical care, such as muscle relaxants, hot packs; (3) manipulation and/or mobilization may be beneficial for muscle tension headache. Their conclusions: lumbar (lower-back) spinal manipulation hastens recovery from uncomplicated, acute (less than 3 weeks' duration) low-back pain. Not enough data were available to evaluate its long-term effect on chronic (more than 13 weeks' duration) low-back pain Is chiropractic care appropriate? Yes, roughly half the time for acute low-back pain, which is on a par with appropriateness ratings of conventional medical procedures used for some other conditions (Shekelle et al., 1998 I've deleted claims referenced to Rand that are not here82.35.214.10 21:14, 4 April 2006 (UTC)

No article for Spinal manipulation at present

.....only a redirect. There should be such an article, just as there are two articles for subluxation, one for the orthopedic (medical) one, and one for the chiropractic version, the vertebral subluxation (VS), and two articles for kinesiology, one for the scientific one, and one for pseudoscientific applied kinesiology (AK). -- Fyslee 21:26, 21 August 2006 (UTC)

I certainly think there ought to be two different articles (one for spinal manipulation and one for spinal adjustment). In the spinal manipulation article, the research that deals with spinal manipulation (and not the chiropractic spinal adjustments in particular) should be included. This article - the spinal adjustment article - should only include research which only studies chiropractic spinal adjustments. You and I both agree that there is a difference... both in technique and intention. Putting research about general spinal manipulation here is misleading to the reader. The confusion between the two must end. Let's disambiguate. Levine2112 21:43, 21 August 2006 (UTC)

I'm not sure we can totally seperate the two. IOW, spinal manipulation can be part of spinal adjustment, but spinal adjustment is not part of spinal manipulation. Chiropractors perform spinal manipulation, but PTs do not profess to perform spinal adjustments. In fact, when they do, they are frequently arrested for practicing chiropractic without a license. The spinal adjustment's purpose is to reduce the subluxation (or some variation thereof) while the spinal manipulation is used as an adjunctive therapy. It's the difference between aspirin used once to treat a headache vs aspirin used daily to prevent heart attack. You do not prevent a heart attack by taking aspirin the way it prescribed for headache just as you would not take aspirin to prevent headaches, though you might have the uninintended effects of either with either. But I don't have to tell either of you that. --Dematt 14:49, 23 August 2006 (UTC)

My addition here explains the "essential" (but not only) difference. In addition to the difference in "intention," other differences exist. They have to do with definitional differences between orthopedic subluxations and vertebral subluxations, as well as the wide diversity of what chiropractors lump together as adjustments. For example, the Activator is postulated as providing an adjustment, when in fact it only taps. There is no proven "adjustment" of anything in the joint. Other "softer" versions of adjustments are anything but an HVLA manipulation that actually affects the joint.

Dematt's point is well taken. An adjustment usually includes a manipulation, but a manipulation is not intended to treat subluxations. Since vertebral subluxations are defined in such a way as to possibly include real orthopedic subluxations (a rare thing for which manipulation is contraindicated), and a whole host of other conditions that MDs and PTs give other names, it becomes more difficult to define what's going on. Until the definition of VS is limited to the same definition as subluxation, there will always be problems in communication.

The legal difficulties have originally been claimed by the ACA president as a means of ensuring that only DCs maintained the exclusive legal right to perform adjustments for the purpose of correcting subluxations. The true intentions have been more obvious when PTs have been prosecuted for performing "manipulation" (with no intention of correcting subluxations). The true intention is obviously to corner the market on all forms of spinal manipulation for any purpose, thus eliminating the right of MDs and PTs to use manipulation for other purposes than exclusively chiropractic purposes. The ACA president went so far as to declare that the fight to corner manipulation would extend to MDs and all others than DCs. -- Fyslee 17:35, 23 August 2006 (UTC)

That's very interesting, Paul... about the ACA president. Can you point me to where he states the "cronering the manipulation market" bit in context? Thanks. Levine2112 18:15, 23 August 2006 (UTC)

Sure. Of course those aren't his words, but he is pretty direct, and subsequent (and previous) lawsuits against other practitioners, including PTs, has shown my interpretation is correct. Here's what I wrote about it in 2001:

• Manipulation "to correct a subluxation"

His exact quotes are near the bottom, but the preceeding parts are worth reading. He states:

"We will continue to pursue this lawsuit until we're assured that only doctors of chiropractic are allowed to provide this service to Medicare + Choice beneficiaries."

-- Fyslee 18:29, 23 August 2006 (UTC)

I would love to see the orignal article. But I would also like to note that the president doesn't seem motivated to corner the market for the business but rather for the benefit and concern for patients. He did say, "Nobody but a doctor of chiropractic is qualified to perform manual manipulation to correct a subluxation-not a medical doctor, not an osteopath." He believes that only chiropractors are trained well-enough in manipulating/adjusting the vertebrae. Anyone else, could be putting patients at risk and may not be effectively delivering all of the benefit of a spinal adjustment. I am sure he is interested in protecting his business as well... he is the ACA president after all. It is his job. But given the statements which you provided, that can only be inferred. Practitioner qualification is what he clearly talking about here. Levine2112 18:38, 23 August 2006 (UTC)

I believe that the key to the wording is manual manipulation to correct a subluxation. Wasn't there some kind of movement by HMOs to only allow PTs to manipulate in medicare as they were saying that PTs could treat subluxations, even though PTs don't treat subluxations. --Dematt 21:42, 23 August 2006 (UTC)

Why and when would anyone else use spinal manipulation

Suppose for hypothetical reasons we accept the argument that chiropractors treat anything that looks like it might be related to the patients condition and call it a subluxation. If we can decide what it is a PT would call it when they decide to manipulate, then maybe we could be able to tell the difference that way. IOW, when PTs decide to use SMT:

• Do PTs just use manipulation when the patient complains of low back pain regardless of the cause, or do they give it a name like lumbar sprain, lumbar intervertebral disc syndrome, facet syndrome, mechanical low back pain, etc..

• How do they decide when and where to manipulate and when not to manipulate. Do they just go by symptoms, or do they have a system such as ranges of motion or set of orthopedic tests that tell them when to start and when to stop?

--Dematt 03:38, 29 August 2006 (UTC)

That's a big one, and you'll get a lot of different answers, depending on who you talk to. One difference would be the use of the word "subluxation" itself, which in a non-chiropractic setting is a strictly "positional" diagnosis, and doesn't deal with possible effects. It's a partial luxation, or partially out of joint, and nothing more. Such a condition will often be a contraindication to spinal manipulation, in the HVLA sense. IOW, non-DCs don't usually manipulate orthopedic subluxations.

The definition of the chiropractic "adjustment" includes various possible, improbable, and claimed effects, and they are embodied in the Vertebral Subluxation Complex (VSC) concept. This concept gives a "subluxation" name to myriad conditions that would (99% of the time) be given another - already existing - diagnostic term by MDs and PTs. They therefore consider DCs to be guilty of misdiagnosing. Rarely do DCs actually manipulate or "adjust" a real (acute) orthopedic "subluxation." Many DCs will usually send such (acute) cases to the ER, as they are very symptomatic and distressing. The chronic types, such as spondylolisthesis (I contributed to that article), aren't amenable to manipulation, which is definitely contraindicated.

Non-DCs may manipulate simply because the patient is used to receiving it from a DC and "demands" it, and if there is no contraindication (I'm in that situation occasionally). They may do it to provide short-lived increased ROM (a chiropractic study from Denmark showed that it really is very short-lived). That would not be considered a complete treatment, and would usually be accompanied with more treatment in the form of joint mobilisation, stretching, excercises, advice, etc.. (I do know PTs who don't do that, and simply stop with a manipulation. They are providing substandard treatment. Some have read too much chiro literature, especially from Planetchiro ....;-) There can be other reasons as well, but the major difference is the disconnect between spinal manipulation and subluxation, caused by it being considered contraindicated. Otherwise MDs, PTs, and DCs may often be manipulating for the same conditions, but giving it different names. Only the DCs will call it a subluxation. Have I succeeded in thoroughly confusing you yet? -- Fyslee 21:09, 29 August 2006 (UTC)

They may do it to provide short-lived increased ROM (a chiropractic study from Denmark showed that it really is very short-lived). That would not be considered a complete treatment, and would usually be accompanied with more treatment in the form of joint mobilisation, stretching, excercises, advice, etc.. (I do know PTs who don't do that, and simply stop with a manipulation. They are providing substandard treatment.

What you are calling the "complete treatment" is similar to what chiropractors are calling a "spinal adjustment." Do you have a name for a "complete treatment?"--Dematt 00:35, 30 August 2006 (UTC)

I guess it's the difference between using just one treatment technique (manipulation/adjustment, exercise, "modalities," or whatever...) or using a series of techniques in a single treatment session. While I know that many mixers do more than "adjust" the spine in such a session, many other chiros, both mixers and of course straights, consider the "adjustment" to be sufficient for a single session. At Planetchiro there are eloquent descriptions of how limiting it to just the adjustment increases results and patient retention, and how adding anything else waters down true chiropractic. In that sense PTs are very much "mixers."

I don't have a "name" for a "complete treatment" at my fingertips. A certain functional problem will often be met with a certain treatment combination that usually works, and it will then be adjusted to the individual patient, since people are different, and even if they have the same diagnosis on paper, their conditions vary quite a bit. None of this is new to you, since you too deal with this all the time. For ultra straights it seems to be a different matter, since they only direct their energies at finding and correcting vertebral subluxations, and thus a medical diagnosis isn't considered to be of relevance to them.

Sid Williams was very firm on this point, and that has colored the education of Life graduates. Since Life was (is again?) the largest chiropractic school in the world, we're talking about many thousands of chiropractors who have this viewpoint, and that fact is considered to be very problematic, not only for patient safety, but also for cooperation and understanding between these chiros and other health care professionals. In fact the attitudes and defective education of these chiros affects the reputations of other chiros who definitely do not share their views. This is an unfair situation, but it's life. Guilt by association is a tough element of human thinking that affects innocent people. That's why chiropractic needs to place a higher priority on policing itself, than on advertising.

Here are a few quotes from him:

Quote:

I accept all cases regardless of the condition. Now when you do that, what kind of potential do you got in your little town of four or five or ten thousand people...what do you see? All this potential.

-Sid E. Williams DC, Founder of Life University, The Meadowlands Experience, Transcript from lecture to Dynamic Essentials practice management group, 1989, p.77, Si-Nell Publishing, Marietta, GA.

Quote:

I'm asking you: what do you want? What do you really want to do? Do you want to be afraid every time you adjust a patient, because you don't know what's wrong with him? What kind of disease does he have? They've all got diseases. The minute we're born aren't we going downhill? How many people have been here a long time? I notice a lot of my friends; they keep disappearing. Do you know what I'm saying?

-Sid E. Williams DC, Founder of Life University, The Meadowlands Experience, Transcript from lecture to Dynamic Essentials practice management group, 1989, p.20, Si-Nell Publishing, Marietta, GA.

Quote:

If you're selling chiropractic you don't have to understand chiropractic, you just have to start believing it, whether it's right or wrong.

-Sid E. Williams DC, Founder of Life University, The Meadowlands Experience, Transcript from lecture to Dynamic Essentials practice management group, 1989, p.89, Si-Nell Publishing, Marietta, GA.

Quote:

No, we're saying that in the beginning subluxations occur, why they occur we don't know. We say there are emotional, nurtitional, psychological, physical causes of subluxations, but do we know any of that? We are just adding and alluding to all the possibilities. It's not necessary for us to know what caused that subluxation.

-Sid E. Williams DC, Founder of Life University, The Meadowlands Experience, Transcript from lecture to Dynamic Essentials practice management group, 1989, p.17, Si-Nell Publishing, Marietta, GA.

Quote:

We don't graduate professionals out here to dignify the world. We graduate you out to make money, right? Is that what you're in here for, or are you just going to be a nice professional and go home and live in a silk cocoon all your life?

-Sid E. Williams DC, Founder of Life University, The Meadowlands Experience, Transcript from lecture to Dynamic Essentials practice management group, 1989, p.29, Si-Nell Publishing, Marietta, GA.

Quote:

What we do is organize what you know in Chiropractic into action programs that help you deliver your service to people. We organize it toward a definite, major purpose of seeing 500 visits per week. Now that 500 visits per week should gross you anywhere from $500,000 to $700,000...write that down, that's a lot of bread isn't it?

-Sid E. Williams DC, Founder of Life University, The Meadowlands Experience, Transcript from lecture to Dynamic Essentials practice management group, 1989, p.28, Si-Nell Publishing, Marietta, GA.

-- Fyslee 09:13, 30 August 2006 (UTC)

I'm not sure where all that fits in, though I would guard against assuming "a lot of chiropractors have this viewpoint". Just because you listen to something does not mean you swallow it whole. Everybody knows Sid was an "evangelist". You take him with a grain of salt and go about your business. The world is not full of little Sids. The Life students that I know thought he was an idiot. But that's another story.

Back on subject.. So basically PTs have the same trouble. IOW, if we erroneously label ultrasound (one PT technique) as PT, then determine ultrasound has killed 15 people by stopping their hearts. But we write down(whether intentional or not); "PT can kill". Or maybe, "Physical therapists kill". You would probably want to illustrate the difference. You would also want everybody to know that PTs know better than to use it over the stellate ganglion or over a pacemaker.

So far all we have, though, is that the two words do not mean the same thing and cannot be used interchangeably. We have to be careful how we use each word.

Apparently, since we're assuming that chiros are treating everything and calling it a subluxation, everyone else is treating a "subset" of those same things. I'm still not sure what "subset" others are treating.--Dematt 14:47, 30 August 2006 (UTC)

When I say "a lot," I'm not making a statement about relative numbers (majority or minority), but just that it's more than a few, and far too many in my book.

As far as the "killing" part, I need you to be more specific and not use examples. It will then be easier for me to provide comments. If you're thinking about the safety issues regarding upper cervical manipulation, you're welcome to use my collection of thoughts here (I didn't create that title) and use my quotes. Maybe you can point out errors in my thinking and help me correct and improve it!

Of course assumptions are rarely totalling accurate, and are just like generalizations - they need to be taken for what they are and no more than that. There are naturally exceptions, sometimes large ones, to every rule. -- Fyslee 18:44, 30 August 2006 (UTC)

copy edits

I've made a number of copy edits, including wikilinks. We need to strengthen the article by providing citations, and by inserting the references in the proper places. Right now many of them are at the bottom. They just need formatting and insertion. We also need to insert some headings to get this organized. Otherwise it's getting better all the time. -- Fyslee 18:03, 8 September 2006 (UTC)

Take a look at your edit here. Do you see what got left out?.....the identification of what the RAND statistics were referring to. It started out fine before the change. -- Fyslee 19:09, 8 September 2006 (UTC)

Lets make a deal, if you see me make a stupid mistake like that one, go ahead and change it before someone else sees it:) If I don't like it, I'll bring it to the talk page and we can discuss it. Sometimes I talk so loud to myself, I can't read;)

• Serious complications due to manipulation of the cervical spine remain rare, having been documented at 1 in 3 or 4 million manipulations or fewer. The current estimate is based on multiple international studies of millions of chiropractic cervical adjustments spanning from present day back to at least 1965.

Are you still okay with this. I think I did see a citation for it awhile back while working on the chiro page. It may have been on the ICA website or somewhere that I was not satisfied it was reliable so I dropped the citation. If I come across it again, I'll drop it in. --Dematt 00:26, 9 September 2006 (UTC)

Well, I've never been comfortable with that addition (I think it was Levine2112), since it was flagrant editorializing language in an attempt to deny any risks at all. He turned what should have been a Safety section designed to increase patient safety, into a section that emphasized how safe chiropractic is (another subject entirely), and completely downplaying any risks associated with upper cervical manips. He even admitted he did it to protect the reputation of the profession, which is an unethical decision, in my books, when it lessens patient safety. Warning messages shouldn't be hidden.

The statistics need to be there, but they should be cited and referenced carefully, and they should all be there, including the whole spectra, with a statement that we really don't know just how great the risk is because of underreporting. The statistics and references for underreporting, misreporting, and (impossible) over-reporting, should also be discussed. -- Fyslee 07:15, 9 September 2006 (UTC)

Duplication needs correction

There is massive duplication of the safety issue. It is found in the preceding section as well, and needs to be concentrated in the Safety section. -- Fyslee 08:40, 30 October 2006 (UTC)

Oops, I made a quick safety check decision. Probably needs some cleanup. --Dematt 14:25, 30 October 2006 (UTC)

I also rewrote the bit about the comparison to cervical neck surgery. The radiating arm and neck pain was not in the source. I also ref the source's source. I don't know if this is okay, but seeing as how we already sourced the source, I figured why not source the source's source and that way we can be extra-sourcy! ;-) Levine2112 17:47, 30 October 2006 (UTC)

I am certainly a source man myself. I'm not big on cheese:) --Dematt 17:49, 30 October 2006 (UTC)

Revamping of Safety section

I have revamped the safety section: grouped related aspects together, added the Di Fabio review, added refs, and retained all the original material, with one exception, where editorializing speculations were tied to a WCA denialist piece which didn't even say what the speculations stated.

I have tried to be true to the existing material, even allowing the self-serving introduction about lower insurance rates to remain (even enlarging it by grouping related material there). Of course chiropractors pay lower insurance rates, since MDs have higher rates because they deal with dangerous conditions. Other professions dealing with less risky conditions also have low insurance rates, so chiropractic is nothing special on the account. I'll let it stand as an obviously self-serving and pleading-type of POV violation. Although it's one-sided and factual, intelligent readers should be able to see through it.

This version really deals with safety issues related to manipulation/adjustments, and is not just an attempt to make chiropractic as a profession look safe. That still gets mentioned in the introdutory part, while the real patient safety issues related to techniques follow. The whole section is now much more informative and logical in its arrangement. -- Fyslee 23:07, 31 October 2006 (UTC)

Straight version of adjustment

This is not exactly what the reference says and I'm not sure it is the most accurate way we can say it:

• The chiropractic choice of wording is often of no consequence, but straight chiropractors will usually make a point of using "adjustment," as a signal for the purity of their "principled" philosophical position.

Any other ideas about what we want it to say? Hughgr, you usually can diiferentiate these pretty well? --Dematt 18:03, 1 November 2006 (UTC)

What exactly is a "straight" chiropractor? --apers0n 19:37, 1 November 2006 (UTC)

ApersOn, the quick answer is that straight chiropractors are the more philosophical school of thought among chiropractors. They tend to use only spinal adjustments without things like physical therapy or "mixing" chiropractic with other remedies. That's where the whole straight vs mixer debate comes in chiropractic. Mixers tend to use other types of treatment protocols as well in an attempt to affect health of the spine or patient. --Dematt 21:13, 1 November 2006 (UTC)

ApersOn, please see the chiropractic article for this difference. Dematt, I think this does sum it up pretty well.

The adjustment is characterized by a specific thrust applied to the vertebra utilizing parts of the vertebra and contiguous structures as levers to directionally correct articular malposition. Adjustment shall be differentiated from spinal manipulation in that the adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation, whereas any joint, subluxated or not, may be manipulated to mobilize the joint or to put the joint through its range of motion.[2]

If anything, I think the crux is the defintion of the words. Perhaps this can be used in lieu of the current sentence.--Hughgr 20:12, 1 November 2006 (UTC)

That is better, I think. --Dematt 20:47, 1 November 2006 (UTC)

Good edits, Hugh. There is one part of that paragraph with which I take issue. There is no doubt that it is an accurate quote, is correctly sourced, and that this is a truly "straight chiropractic" opinion. My objection is that the claim is disputed, which is one of the main reasons for why there is a difference between the definitions of the medical subluxaton and the chiropractic vertebral subluxation. The chiropractic claim (not just "straight" chiropractic) is that "articular malpositions" are "corrected." To the best of my knowledge this has never been proven, not only with x-ray, but even with scanning. Even some chiropractors dispute this, and those who do dispute it still manipulate, but only to improve ROM, not to correct VS or improve the flow of Innate intelligence, or to improve general health, or to cure any organic diseases. -- Fyslee 21:37, 1 November 2006 (UTC)

What is your source?--Hughgr 06:15, 2 November 2006 (UTC)

Good question. The first part ("never been proven") is a falsifiable comment. Of course what is deemed acceptable "proof" in this case means different things to DCs on the one side, and MDs/PTs, etc. on the other. The medical world is not yet convinced by the chiropractic claims of proof. To make it worse, so many aspects are mixed up in the differences in definitions of the same word that it gets pretty hard to explain or "prove." That's why I think that the chiropractic use of the word "subluxation" is a confusing misuse of the term that creates many more problems for the profession than it is worth. Keating and others (like Carter) say basically the same thing.

Carter's basic message below (and in the whole article) is that adherence to "subluxation" is the "silent killer" of chiropractic:

It appears that a small segment of our profession, with some elected leaders, appear intent on answering this crisis with only the 1910 chiropractic subluxation model. Their approach is not only wrong, but it prevents what is right from being done. Dr. Darrel Ladell stated it so well in his report on the Radiology Issue: Beware of the enemy for he is us.

Subluxation, though a vital part of our history has been described as the Achilles Heel of our profession. When you review the available literature and combine it with knowledge of our history, it quickly shows where the subluxation model has failed. This model has cost us years of positive growth.

This paper proposes that there is no need to beat our profession up again, punishing us with a misdirected allegiance to our dysfunctional history....

Today, the molding of the future of chiropractic in parts of Canada is being shaped by some elected members and volunteers who appear to have an obsession with only the subluxation model of chiropractic while being blinded to the many other very positive options. To challenge this philosophical position one should review the wealth of evidence from our past that indicates this model is not only ineffective but, at times, has been extremely damaging to the profession. Subluxation, unfortunately with a great deal of truth, has been referred to as the “Achilles Heel” of chiropractic....

The direction of this paper will now examine and discuss the chaos “subluxation” has created in different contingencies of the chiropractic profession. It may well be the silent killer of the chiropractic profession. Understanding this threat will enable you to know our enemy. (Beware of the enemy for he is us.)...

Certainly how we define one word, subluxation, should not create these emotions which divide the profession. Its more than a word, it represents belief systems, different philosophies, it challenges our ethics, it provides the different factions an issue to fight about. Our own justification of this word allows us to keep, and observe our peers breaking, the Eleventh Commandment: Thou shalt not take advantage of the sick.....

(Long passage about NACM, NCAHF, Duval, Slaughter, Homola, Keating, etc..)

Reformist Samuel Homola, D.C. has noted that the orthopaedic subluxation is an obvious and detectable entity (presenting obvious local symptoms), while the chiropractic subluxation is theoretical, elusive, and primarily an imaginary process to which the chiropractor has attached the primary cause of disease.

Reformist Peter Modde, D.C., has pointed out that if chiropractic subluxation theory were correct, people with scoliosis would have every disease mentioned in chiropractic “nerve charts” and quadraplegics could not live. Joseph Keating, Jr., Ph.D., an out spoken chiropractic educator, considers the philosophy subluxation a “holy word” that has outlived its usefulness and “will become an increasing embarrassment.” But Craig F. Nelson, D.C. another outspoken educator recently lamented that “the number of chiropractors who are animated by 19th century pseudoscience seems to be growing rather than shrinking, and these chiropractors will abandon their philosophy when hell freezes over”

Haldeman also states that minor misalignments of vertebra “are normal and not necessarily a sign of trouble”...

“There is a picture developing. Those who would choose success will see the picture early and understand it. Remember the laws mentioned earlier which govern our lives. You either get it, or you don’t was the first law with a strategy of becoming one of those who get it.”38 In the last 100 years we have being telling about the big picture, the subluxation. The public hasn’t got it, the scientific community hasn’t got it, many chiropractors haven’t got it, and the government and health care planner haven’t got it. Who has got it are the 15% of those who profess to be straight or principal based chiropractors....

The evidence for subluxation is almost non-existent in peer reviewed data, however, “... manipulation/adjusting is well established in more than 30 randomized clinical trials studying the effectiveness of spinal manipulation. There are eleven studies on the effectiveness of manipulation on chronic low back pain. There are seventeen studies looking at the relative costs of chiropractic. There are numerous studies that show an overall reduction in costs in work time lost. All studies have looked at the degree of patient satisfaction in patients seeking manipulation or chiropractic care have demonstrated much higher patient satisfaction scores compared to other forms of treatment and other professions.”...

Those attempting to push the subluxation model while believing in professional isolation can no longer be tolerated.

It is now time for the silent majority to make their voices heard. Remaining silent increases the division, dulls our focus and weakens the science of chiropractic to a point of potential collapse. The subluxation story regardless of how it is packaged is not the answer.

-- Subluxation - The Silent Killer, A 2000 commentary by Ronald Carter, DC, MA, Past President, Canadian Chiropractic Association in the Journal of the Canadian Chiropractic Association

If chiropractic is to survive at all, then its "killer" (the chiropractic vertebral subluxation) must die.

I hope these thoughts from the inside of chiropractic will inspire you all to make changes within the profession. These are just might thoughts here, and certainly not for the article. -- Fyslee 13:14, 2 November 2006 (UTC)

Ummm, O.K.--Hughgr 19:02, 2 November 2006 (UTC)

New article - Joint manipulation

Check out the new article - Joint manipulation. Much is contained in the article here, but I have added more refs and information, as well as making sure that readers understand that the risks apply to all professions using manipulation/adjustment, not just to chiropractors, even though they are using it 95%(?) of the time. Some of what I have added there can also be used here. -- Fyslee 16:12, 5 November 2006 (UTC)

Teriffic. Nice work. Let's take advantage of the fact that we have an electronic encyclopedia and not be so specific in the more general Joint Manipulation page. There is much more to joint manipulation that spinal adjustments. Certainly, the work of Osteopaths, et cetera should be discussed and overall the page should be kept more general. Levine2112 22:53, 5 November 2006 (UTC)

Citation request for common knowledge?

A request has been made for a citation regarding common knowledge about ordinary chiropractors (not specifically straight chiros):

• "While the terms "spinal adjustment" and "spinal manipulation" are often used interchangeably by chiropractors in their literature and research , most straight chiropractors tend not to use the term "manipulation," preferring to use the word "adjustment" to describe the nature of their work."

Just how many citations will be necessary to get the citation request removed from the article? If someone asks for proof that Norwegians often speak Norwegian, I guess one would have to round up a group of them and get them to prove they could speak Norwegian. In this case, just how many websites, papers, articles, and research studies written and performed by chiropractors do we need to produce, showing numerous examples where they use the term "manipulation" when referring to what chiropractors do ("adjust")? Just a simple Google search of that archetypical chiropractic production, Dynamic Chiropractic, should be able to provide some examples:

• Google search: manipulation site:www.chiroweb.com - 1,610 hits

(just for the fun of it, I did a search for "adjustment" on the same website):

• Google search: adjustment site:www.chiroweb.com 1,490 hits

I would expect that a similar search of a straight chiropractic journal would produce proportionally more hits for "adjustment" than for "manipulation," but then we aren't discussing proportions here, just that the terms "are often used interchangeably by chiropractors."

Citation requests need to be reserved for truly controversial matters, and not for common knowledge. -- Fyslee 11:40, 6 November 2006 (UTC)

The thing is that the word "Norwegian" implies it is a language spoken natively in Norway, and so is unlikely to be challenged. WP:CITE says "All material that is challenged or likely to be challenged needs a source". The Google searches above are a good idea, and can be used as a reference:

<ref>{{cite web |url=http://www.google.com/search?hl=en&rls=GGLJ,GGLJ:2006-37,GGLJ:en&q=manipulation+site:www%2echiroweb%2ecom |title=manipulation site:www.chiroweb.com - Google Search |accessdate=2006-11-06 |publisher=Google |quote=Results 1 - 10 of about 1,610 from www.chiroweb.com for manipulation. }}

{{cite web |url=http://www.google.com/search?hl=en&lr=&rls=GGLJ%2CGGLJ%3A2006-37%2CGGLJ%3Aen&q=adjustment+site%3Awww.chiroweb.com |title=adjustment site:www.chiroweb.com - Google Search |accessdate=2006-11-06 |publisher=Google |quote=Results 1 - 10 of about 1,490 from www.chiroweb.com for adjustment. }} </ref>

Dictionary definitions are not really up to the subtlety, see http://en.wiktionary.org/wiki/manipulation and http://en.wiktionary.org/wiki/adjustment --apers0n 14:17, 6 November 2006 (UTC)

It looks like there is some overlap and confusion here concerning the use of terms by each of the professions and even within the professions. What may seem as "common knowledge" to a professional within a particular profession, may have a totally different connotation in another. Perhaps we need to reference all of our sources for a little while until we all find out what each of us is taking about. It will take a little more effort initially, but should pan out before we're finished. Any thoughts?--Dematt 15:33, 6 November 2006 (UTC)

History?

Perhaps a little history of the terms and procedures might help to differentiate adjustment and manipulation? --Dematt 15:42, 6 November 2006 (UTC)

Techniques

I was thinking that now that we have an article dedicated just to the adjustment, perhaps we could use it to describe the most notable of the techniques out there. Broadly, let me humbly offer this as a starting point to help organize out thoughts...

• Toggle Drop - this is when the chiropractor, using crossed hands, presses down firmly on a particular area of the spine. Then, with a quick and precise thrust, the chiropractor adjusts the spine. This is done to improve mobility in the vertebral joints.

• Motion Palpation - this hand-on procedure is done to determine if your vertebrae are moving freely in their normal planes of motion.

• Lumbar Roll -the chiropractor positions the patient on his or her side, then applies a quick and precise thrust to the misaligned vertebra, returning it to its proper position.

• Release Work - the chiropractor applies gentle pressure using his or her fingertips to separate the vertebrae.

• Table adjustments - The patient lies on a special table with a "drop piece". The chiropractor applies a quick thrust at the same time the table drops. The dropping of the table allows for a lighter adjustment without the twisting positions that can accompany the manual adjustment.

• Instrument adjustments - often the gentlest methods of adjusting the spine. The patient lies on the table face down while the chiropractor uses a spring-loaded activator instrument to perform the adjustment. This technique is often used to perform adjustments on animals as well.

• Manipulation done under anesthesia (or twilight sedation) - this is performed by a chiropractor certified in this technique in a hospital outpatient setting when you are unresponsive to traditional adjustments.

Then maybe we could get down to the specifics within each category? Gonstead, Specific, Thompson Table, Diversified, SOT, Flexion-Distraction, et cetera.

Thought? Levine2112 01:45, 7 November 2006 (UTC)

You read my mind. I was trying to prepare the article for that same thing. Today's chiropractors use several different techniques with the intention of affecting the nervous system for health benefits. This is the place for them. --Dematt 01:54, 7 November 2006 (UTC)

I like this candid statement by you above... Today's chiropractors use several different techniques with the intention of affecting the nervous system for health benefits. Something like that would be nice for an intro to this new section. Many of these techniques have websites dedicated to their promotion and research. I will attempt to add a few to my list above. Levine2112 02:32, 7 November 2006 (UTC)

Sometimes I surprise myself;) Take a look at what I've done so far and let me know what you think. We are going to need the some references and examples for sure. I figure there will be lots of techniques popping up before its over. Do we want to use any type of criteria or do we let it all in? --Dematt 03:10, 7 November 2006 (UTC)

I'm going to go ahead and put the list that you started above. We can work with it from the article later. --Dematt 03:13, 7 November 2006 (UTC)

Okay, it's somebody else's turn! --Dematt 03:36, 7 November 2006 (UTC)

Me likey. Now we should explore the various adjustment styles... especially the most popular and notable. Some are HVLA, but there are many which are low force adjustment styles. How does making a list and a brief description of each style sound? Recommendations of which styles to include? Gonstead and Diversified for sure. Which others? Levine2112 17:54, 7 November 2006 (UTC)

We did have a list that was dropped by the chiro page [3]. I don't know what all these are or if they are still used at all, but maybe we can pick a few and somebody will know something about each. Either that or we have to do a lot of research;) --Dematt 18:04, 7 November 2006 (UTC)

Okay, here's what that list is...

• Activator Methods - uses the Activator Adjusting Instrument to give consistent low-force, high-speed chiropractic adjustments.
• Active Release Therapy (or Active Release Technique) - soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves.
• Cox Flexion-Distraction - a gentle, non-force adjusting procedure which mixes chiropractic principles with osteopathic principles and utilizes specialized adjusting tables with movable parts.
• Directional Non-Force Technique - utilizes a diagnostic system for subluxation analysis consisting of gentle challenging and a unique leg check allowing the body to indicate the directions of misalignment of structures that are producing nerve interference. A gentle but directionally specific thumb impulse provides a long lasting correction to bony and soft tissue structures.
• Diversified - the classic chiropractic technique, developed by D.D. Palmer, DC. Uses specific manual thrusts focused on restoring normal biomechanical function. Has been developed to adjust extremity joints as well.
• Gonstead Technique - Developed by a mechanical engineer turned chiropractor, this technique uses a very specific method of analysis and precise adjusting techniques
• Kale Technique (Specific Chiropractic) - gentle technique which utilizes a special adjusting table that helps adjust and stabilize the upper cervical region surrounding the brain stem.
• Logan Basic Technique is a light touch technique that works to "level the foundation" or sacrum. It's concept employs the use of heel lifts and specific contacts.
• NUCCA Technique - manual method of adjusting the atlas subluxation complex based on 3D x-ray studies which determine the correct line of drive or vector of force.
• Thompson Terminal Point Technique (Thompson Drop-Table Technique) - Uses a precision adjusting table with a weighing mechanism which adds only enough tension to hold the patient in the "up" position before the thrust is given.
• Toggle Recoil Technique - a quick thrust and release to the upper cervical, allowing the body's wisdom to reposition spinal segments with the least possible amount of force.

The ones below are lesser known or aren't specifically a chiropractic spinal adjustment technique or an oversight. Please feel free to copy from below and add above if I have overlooked something notable and relevant.

• Advanced BioStructural Correction
• Advanced Muscle Palpation
• Alphabiotics
• Applied Chiropractic Distortion Analysis
• Applied Kinesiology
• Applied Spinal Biomechanical Engineering
• Aquarian Age Healing
• Arnholzt Muscle Adjusting
• Atlas Orthogonality Technique
• Atlas Specific
• Bandy Seminars
• Barge Technique
• Bio Kinesiology
• Bio-Energetic Synchronization Technique (BEST)
• BioSET (Bioenergetic Sensitivity and Enzyme Therapy)
• Bioenergetics
• Bio-Geometric Integration
• Biomagnetic Technique
• Blair Upper Cervical Technique
• Buxton Technical Course of Painless Chiropractic
• Cerebrospinal Fluid Technique (CSFT)
• Chirodontics
• Chiroenergetics
• Chiro Plus Kinesiology
• Chirometry
• Chiropractic Biophysics (CBP)
• Chiropractic Manipulative Reflex Technique
• ChiropracticNeuro-Biomechanical Analysis
• CHOK-E System
• Chrane Condylar Lift
• Clinical Kinesiology
• Collins Method of Painless Adjusting
• Columbia Technique
• Contact Reflex Analysis (CRA)
• Craniopathy
• Endo-Nasal Technique
• Extremity Technique (Ext)
• Focalizer Spinal Recoil Stimulus Reflex Effector Technique
• Freeman Chiropractic Procedure
• Fundamental Chiropractic
• Global Energetic Matrix
• Grostic Technique
• Herring Cervical Technique
• Homeokinetics
• Howard System
• Keck Method of Analysis
• King Tetrahedron Concept
• Laney Technique
• Leander Technique
• Lemond Brain Stem Technique
• Life Upper Cervical
• Master Energy Dynamics
• Mawhinney Scoliosis Technique
• McTimony Technique
• Mears Technique
• Meric System
• Micromanipulation
• Mitza Neuroemotional Technique
• Morter HealthSystem
• Motion Palpation
• Muscle Palpation
• Muscle Response Testing
• MusculoSkeletal Synchronization and Stabilization Technique
• Myofascial Technique
• Nambudripad's Allergy Elimination Technique (NAET)
• Nasal Specific
• Nerve Signal Interference (NSI) Removal
• NerVerteBraille
• Network Chiropractic
• Neural Integration Technique
• NeuroCranial Restructuring (NCR)
• Neuro Emotional Technique
• Neuro Lymphatic Reflex Technique
• Neuro Organizational Technique
• Neuro Vascular Reflex Technique
• Nimmo Receptor Tonus Technique
• Olesky 21st Century Technique
• Orthospinology
• Ortman Technique
• Perianal Postural Reflex Technique
• Pettibon Spinal Biomechanics
• Pierce-Stillwagon Technique
• Posture Imbalance Patterns
• Polarity Technique
• Pure Chiropractic Technique
• Reaver's 5th Cervical Key
• Receptor Tonus Technique
• Riddler Reflex Technique
• Rumpt Technique
• Sacro-Occipital Technique (SOT)
• Soft Tissue Orthopedics (ST)
• Somatosynthesis
• Spears Painless System
• Specific Majors
• Spinal Stressology
• Spinal Touch Technique
• Spondylotherapy
• Sutter Upper Cervical Technique
• Sweat Adjusting Technique
• Tensegrity Therapy
• Tiezen Technique
• Toftness Technique
• Top Notch Visceral Techniques
• Tortipelvis / Torticollis
• Touch for Health
• Total Body Modification (TBM)
• Truscott System
• Torque Release Technique
• Triunified Health Enhancement System
• Ungerank Specific Low Force Technique
• Variable Force Technique
• Von Fox Combination Technique
• Webster Technique
• Zimmerman Technique
• Zindler Reflex Technique

I'm going to research the one I've at least heard of and add their "definition" here. Any help would be appreciated (as always)! Levine2112 18:25, 7 November 2006 (UTC)

I have added a "Techniques" sub-section to the Methods section and included the ones which I hhave defined above. Levine2112 19:45, 7 November 2006 (UTC)

I don't believe we should have a long list on this art., maybe its own article if a list that long is desired. I feel this article should only mention the most commonly used tech. with a breif description, like it is :) --Hughgr 19:52, 7 November 2006 (UTC)

I agree. What do you think of the current list on the article? Anything missing? Too much? Levine2112 19:53, 7 November 2006 (UTC)

I think that is good enough. If someone comes along and wants to add one, we can evaluate it then and decide how to integrate it. Remember that guy who asked a question about Pettibone.. this would be a good place for him to put it. --Dematt 21:10, 7 November 2006 (UTC)

Great, then I am going to take a break for now on this. Levine2112 21:13, 7 November 2006 (UTC)

Much deserved I might add, thanks for your good work. --Dematt 02:01, 8 November 2006 (UTC)

I must admit that I think the sections are great additions to the article. They really don't take up all that much space (yet). This isn't a very long article as yet, but if it gets too long, then it might be a good idea to split it into a separate article. Otherwise it looks great. Very good work. BTW, what about HIO? -- Fyslee 21:39, 8 November 2006 (UTC)

Duh, of course H.I.O.!!! --Dematt 22:00, 8 November 2006 (UTC)

Isn't Specific/Kale a more widely used, clinically updated version of H.I.O.? I believe practitioners even use a similar kneeling table similar to the one BJ developed. Levine2112 23:51, 8 November 2006 (UTC)

I have no idea. Maybe Hughgr knows? I have a feeling that most of these aren't even techniques or at least have not been used for 70 years. --Dematt 00:06, 9 November 2006 (UTC)

But the ones currently listed in the article are all adjustment techniques and are all currently used. Yes? Levine2112 00:18, 9 November 2006 (UTC)

Oh yes, and many more, but there are names on there that look pretty specific to a particular chiropractor who probably died a long time ago;) Sort of like all those orthopedic tests like Laseques, Bechterews, Burns Bench test, Wartenburg, McKensie exercises(you know - the physical therapist), and the many more medical doctors that "invented" tests that were basically ranges of motion, but they put their names on them because it would outlast them. I guess that was the way they did things back then. I'm okay with it as long as they are. --Dematt 00:26, 9 November 2006 (UTC)

Hi, I don't know anything about Kale. At Palmer (1999) we were taught "Toggle recoil" for the upper cervicals. Not called HIO anymore, I guess. Adjusting with a similar technique on other levels, but without the "recoil", was called "single hand contact" (SHC), which is what the article describes as the "crossed hands"....I'm not sure how we should procede with this, due to similar tech. having different names. We were taught "Thomphson technique" and "modified rotary break", etc., I don't recall that one having a person's name attached to it :) "Lumbar roll" was called "side posture", etc.. I think we should keep it simple, there's no need to list every technique ever dreamed up, just the most used one's as examples should suffice.--Hughgr 02:34, 9 November 2006 (UTC)

I agree with KISS. Go ahead and make the changes you were talking about, because that is the way I remember it as well. You seem to have a good handle on the differences. I just use diversified and cox. I didn't take toggle recoil or gonstead, but was aware of their system and was always in awe of their discipline. --Dematt 02:54, 9 November 2006 (UTC)

I tend to look at the various techniques as tools as there isn't one technique that's perfect for everybody in every situation. As far as what to list in the article, there must be a list of sorts showing the most widely used techniques. I'm getting too wikied :) there must be a V RS somewhere out there...--Hughgr 06:55, 9 November 2006 (UTC)

Factual Verification tag removed

I think we are "good enough" at this point to remove the tag... which I did. I'd like to work on getting the POV tag removed next. What are the issues? Levine2112 18:22, 8 November 2006 (UTC)

I assume it is there because of the safety issue? --Dematt 18:51, 8 November 2006 (UTC)

Okay. Then let's see what happens on Joint manipulation first. Sound like a plan? Or is there something we can do here first/concurrently to resolve the POV tag issue? Levine2112 19:56, 8 November 2006 (UTC)

Lets work the two together so we can take them all off at the same time. --Dematt 20:37, 8 November 2006 (UTC)

Misaligned vertebrae

The use of certain wording representing very fundamental and common concepts (and unique to chiropractic) brings up an NPOV issue. Here's an example:

• Lumbar Roll (aka side posture) - the chiropractor positions the patient on his or her side, then applies a quick and precise manipulative thrust to the misaligned vertebra, returning it to its proper position.

Here we have two wordings describing the concept:

• "misaligned vertebra"

• "returning it to its proper position"

Here are a few more examples:

• "abnormal alignment"

• "manipulative thrust to the misaligned vertebra, returning it to its proper position."

• "A gentle but directionally specific thumb impulse provides a long lasting correction to bony and soft tissue structures."

• "misalignment of structures"

• "to directionally correct articular malposition"

• "adjustment can only be applied to a vertebral malposition with the express intent to improve or correct the subluxation"

The problems caused by these concepts have even influenced changes in federal (Medicare) law. The legal framework (under Medicare) for getting payment is intimately connected with the subluxation and X-ray demonstration of its existence. The ability to prove its existence by X-ray was so problematic that the X-ray requirement was finally dropped in 2000, thus legalizing a fictive lesion. Now the word of even the most imaginative of super straight chiropractors is enough, with no objective proof being required at all. Here is the sequence of events, as documented in an OIG report:

"the existence of a subluxation must be documented through an X-ray or physical examination"

"Medicare carriers routinely deny all chiropractic claims that do not carry a code for spinal manipulation, which is, by law, the only treatment for which chiropractors may be reimbursed."

"On October 30, 1972, Congress passed the Social Security Amendments of 1972, extending Medicare reimbursement to chiropractors, but only for manual manipulation of the spine to correct a subluxation demonstrated by an X-ray."

"In 1986, OIG released a report entitled Inspection of Chiropractic Services under Medicare(OAI-05-86-00002). OIG found that because of disagreement about the ability of an X-ray to reveal a subluxation, the existing X-ray requirement was not well enforced, might actually have been unenforceable, and was highly conducive to abuse. In addition, the report described a lack of standards within the chiropractic profession and a number of questionable practices. For these reasons, OIG concluded that chiropractic constituted a serious vulnerability to the Medicare program."

"The Balanced Budget Act of 1997 removed the X-ray requirement as of January 1, 2000, and instructed the Secretary of the Department of Health and Human Services to establish utilization guidelines for subluxations not evidenced by an X-ray. Guidelines for demonstrating a subluxation are found in section 2251.2 of the Medicare Carriers Manual (the Manual).8 The Manual defines a subluxation as "a motion segment, in which alignment, movement integrity, and/or physical function of the spine are altered although contact between joint surfaces remains intact." If used, an X-ray generally must be taken between 12 months before and 3 months after the start of treatment. A physical examination must identify at least two criteria for treatment, one of which must be asymmetry/misalignment or a range of motion abnormality. The other criterion can be pain/tenderness or changes in the associated soft tissue."

"Further Discussion of the Effects of Removing the X-ray Requirement

"National Claims History data strongly suggest that removing the X-ray requirement spurred an increase in the number of beneficiaries receiving chiropractic care. As shown in Figure A-1, the proportion of Medicare beneficiaries using chiropractic services grew fairly steadily from 4.6 percent in 1994 to 4.8 percent in 1999, at a rate that approximately mirrored that in Americans less than 65 years old.17 In 2000, the Medicare proportion jumped to 5.5 percent, roughly 2.5 times the combined increase from the previous 5 years, with no evidence that this change was reflected in the under-65 population. Medicare did not issue any policy changes other than removal of the X-ray requirement, or experience any shifts in its population (such as changes in the proportion of beneficiaries in rural areas) that would account for this increase."

Source: Chiropractic Services in the Medicare Program: Payment Vulnerability Analysis DHHS, June 2005 OEI-09-02-00530

As you are no doubt aware, this wording and belief is one of the major aspects of chiropractic that is disputed, and of course is integral to the concept of vertebral subluxation and the meaning of the word "adjust," in contrast to the word "manipulate" (which doesn't necessarily imply any real change of position). "Misaligned" simply means one thing to a chiropractor, and something different to others.

I am not suggesting that it shouldn't be used in the article, but it needs to be pointed out that it is a uniquely chiropractic belief that is disputed (and therefore hardly used at all) by MDs, radiologists, PTs, and the rest of the healthcare system. When they do use it, it is for much more serious conditions that are often not amenable to HVLA.

There are even techniques (especially the Activator) that don't even have a remote possibility of moving a "misaligned" vertebra (no matter how it is defined) into another position, IOW it can't correct a misalignment. Yet this is called an adjustment technique. The Activator is even considered so much of a scam that one or more of the Canadian provincial chiropractic societies forbid its use for many years, and called into question whether it "adjusted" anything. [4]

If such a technique can qualify as "adjusting" "misalignments," then chiropractic is obviously working with a non-standard definition. Just how do chiropractors really understand this matter? I'd like to hear the chiropractors here explain this. -- Fyslee 12:39, 9 November 2006 (UTC)

Yeah, we do need to handle that. So, first of all, I think you put way too much into it. Certainly nothing in the life sciences is rock solid like you are requesting. I could just as easily ask what is the famous "Gait Theory." Is there really a gate that opens and closes? And if not, why mislead people by misnaming it like that. But I wouldn't ask you that; because I understand it is a theory that allows us to build a framework within which to explain the things that we observe. From there we can attempt to effect the outcomes that we hope to achieve. This is just one example, there are thousands, but hopefully you get the picture.

Having said that, lets look at what we have;

• Chiropractors adjust subluxations.
• If we look at our WP defintion of spinal adjustment we can substitute;
  • Chiropractors use any of a number of specialized manual or mechanical procedures in an effort to affect the alignment, motion and/or function of spinal joints and their relationship with the nervous system.

Certainly this can and does include manipulation as well as a lot of other methods in an effort to affect the alignment, motion and/or function of spinal joints and their relationship with the nervous system.

If we look at "and their relationship with the nervous system." That can entail the same effects that you use to explain joint manipulation with Type I,II,III, IV an V mechanoreceptors that "theoretically" relay information for proprioception and can help to modulate pain via the "theoretical" Gate theory. Those are effects on the nervous system. It "may" also include other "theoretical" possibilities that "may" affect the visceral and organ systems via some other currently "speculative" mechanism via the autonomic ns.

I think the medicare dilemma fits in there. Bottom line is that the definition of subluxation includes everything that that would affect alignment, motion, and the nervous system. Medicare requires us to use "segmental dysfunction" which describes it pretty well, too. They just won't pay us to do the physical therapies like they do you. So how do we fit this in to the article? --Dematt 16:01, 9 November 2006 (UTC)

the disambiguation tag

I changed the tag to reflect the discussion on the joint manipulation page regarding how some SA does include SM, so even subluxation based DCs use SM. Let me know if there is anything that is not clear, or if we can make it clearer. --Dematt 16:41, 19 November 2006 (UTC)

Stray references

I junked some unreffed references from the bottom under the actual footnoted refs. I believed these to be fall-out from a time when this article was not in the good shape it is today. Levine2112 02:38, 21 November 2006 (UTC)

Merger with Spinal manipulation

Given that the physical act of spinal adjustment is the same as spinal manipulation. These two articles should be merged. To avoid WP:SYN violations, conclusions drawn from SMT should not be directly applied to Osteopathic medicne, Physical Therapy, Chiropractic or other health care disciplines that use this type of manual medicine. Soyuz113 (talk) 19:16, 6 September 2008 (UTC)