Pacific Beach Chiropractic Associates

According to a specialist in La Jolla, chiropractic injuries are often “appalling," and can only be corrected by an orthopedic surgeon.

• Skeletons are horrors; they dink and tinkle and rattle in old castles, hung from oaken beams, making long, indolently rustling pendulums on the wind....
• —Ray Bradbury, Skeleton

The real triumph came in August of 1974 when the department of Health, Education, and Welfare recognized an accrediting agency for chiropractic colleges.

Ian Dryden

THE PROTAGONIST IN Bradbury’s short story, a Mr. Harris, complains to all the right doctors and specialists about aches in his bones, and after finding no relief, turns in his exasperation to a small, dark man, M. Munigant, whose name in the Yellow Pages under “Bone Specialists” is the only one without academic letters behind it.

As it turns out, Munigant “treats” people like Harris by making them aware of the “other being" inside them, their skeleton, and when these already-neurotic patients have become sufficiently convinced of the malicious ambitions of their bony interiors, he administers to them by completely removing their skeletal frame, leaving behind a literal jellyfish of a human being. Munigant, you see, has a peculiar appetite for human bones.

To most people such an incredible script might seem only morbidly amusing, but to the young man who sat rigidly in the waiting room of a local chiropractor’s office, the idea of bones, particularly the spinal column, gaining complete control of a person’s body and soul was not at all far-fetched. He had been showering only 24 hours before when, in the simple act of shampooing his hair, he bent his neck forward too far and felt a twinge of pain between his shoulder blades. Within two hours the pain had spread to engulf his entire neck and back, rendering him practically immobile, and excruciating exercise. As his condition grew worse, he remembered that a friend's mother had injured herself in a similar mishap. She had gone to her doctor and within a week was being wheeled into an operating room. The possibility of his own injury leading to the same situation frightened him. It was at this point that he decided to see a chiropractor instead of a medical doctor.

By (he time he had reached the chiropractor’s office, it had been necessary for his family to wrap his neck tightly with towels, forming a home-made brace that would hopefully take the place of muscles which were suddenly incapable of support. He sat stiffly on the edge of the chair, his arms like buttresses holding him upright, his glazed eyes staring straight ahead.

His trance was broken suddenly by the voice of the office receptionist calling him by name. With some trepidation, he rose for his appointment. Nearing the hallway he stopped, and though realizing it was too late to change his mind, he had to look one more time at the name on the door. It was Andersen, not Munigant, and with a sigh of resignation he closed the door behind him.

THE PLIGHT OF the young man is not unlike that experienced by millions of Americans every year. For all the money spend annually to educate the public about the dangers of neglecting and abusing one’s heart, lungs, and eyesight, few people are aware of their backs until something unfortunate brings that area under scrutiny. At that point many people discover that the bones in their spine constitute an extremely important part of the body—are indeed “another being.”

Like Mr. Harris in Bradbury’s story, most people who develop aches in their backs or necks still turn automatically to the men in white frocks with the letters "M.D.” on their nameplates. In the last several years, however, more and more people with spinal trouble have eschewed traditional medical care in favor of the slightly clandestine manipulations of a chiropractor. Why clandestine? Simply because the chiropractor has long been considered the “M. Munigant” of medicine. The American Medical Association despises him; orthopedic surgeons have anointed him with the time-honored epithet, “quack”; and stories have long circulated about all the weird things that a chiropractor does to his beleaguered patients. For a long time, anyone who dared to visit a chiropractor whispered his or her confession in muted tones.

In recent years, though, chiropractic care has enjoyed a tremendous period of growth, one which has seen legions of suffering patients successfully treated for a myriad of aches, stiffnesses, and disorders. It is, in fact, the relatively recent popularity of chiropractic care that has most aroused the ire of the medical profession. Where once orthopedic specialists could scoff and snicker behind their backs about the new skinny kid on the block, chiropractic is now being taken seriously by enough people to make such off-handed dismissal impossible. As a result, the A.M.A. and all its spokesmen, official or otherwise, have taken a hard line against chiropractic, labeling it a non-scientific “cult," and referring to its practitioners in the same patronizing manner with which one would speak of witchdoctors and faith healers.

Chiropractors, on the other hand, have been fighting back, at times feebly, but at other times with new-found political clout. The confrontation has become an embittered brawl between those who find the chiropractor’s spinal adjustment theories laughable, and those who decry the M.D.’s automatic scalpel-and-drugs answer to back-related problems.

TO ARRIVE AT an understanding of chiropractic and the controversy surrounding it, it is necessary to know the philosophy that forms the basis for its wide-spread practice. Chiropractic (Greek for “done by hand") has at the core of its theory the belief that almost all physical disorders can be attributed to the dislocation (officially, “subluxation”) of the vertebrae in the spinal column. According to this belief, any disruption of the normal alignment of these vertebrae places undue and unnatural stress on surrounding tissues (muscles, nerves, etc.), but more importantly, on the spinal cord itself. Those who subscribe to the chiropractic theory hold that such an interruption of the normal function of the spinal cord and its related nerves causes other organs to suffer. The chiropractic remedy for this condition is manual readjustment (manipulation) of the spine, so that by returning the vertebrae to their normal positions, any abnormal pressure on the spinal cord is relieved, and the affected organs can return to their regular functions.

This manipulation involves, almost exclusively, a technique known as “dynamic thrust,” in which the chiropractor administers a strong, sudden thrust, with the heel of his hand, to an area of misalignment, thereby “popping” the vertebrae back into place. It results in a clicklike sound that is audible to practitioner and patient alike, and is accompanied by an instantaneous sensation of relief at that point of the spine.

This dynamic thrust procedure is followed up and down the spinal column, including the neck, until all the suspected misalignments are accounted for. In most cases, three or four repeat visits are required, so that any recurring subluxations can be detected and treated. In some cases, the patient may be asked to return once a week for months, until all complications stemming from severe subluxations are satisfactorily remedied.

THE THEORIES BEHIND chiropractic seem plausible enough, and it is natural to assume that something as vital as a man’s spine has always received the attention given it these days by chiropractors. Although there is evidence that a form of spinal manipulation was practiced by the Egyptians centuries before Christ, and that Greek physicians such as Galen included the “repositioning” of dislocated vertebrae in their therapy as early as 200 A.D., there never existed a systematic approach to spinal manipulation until just 82 years ago.

Modern chiropractic was born in 1895 in Davenport, Iowa, at the hands of D.D. Palmer, a faith healer, mesmerizer, homeopath, and neuropath who had for years operated a “magnetic healing” studio in his hometown. One day Palmer was visited by a black janitor who had been deaf since suffering a badly-twisted neck 17 years earlier.

Though not equipped to make an accurate medical diagnosis. Palmer concluded that it was the actual misplacement of the man’s neck that was preventing his ears from working properly. Palmer manipulated the neck back into place, whereupon the man’s hearing was restored. It was this success which inspired Palmer to turn his attentions almost entirely to the study of the relationship between vertebral alignment and good health. Knowing that each of the body’s parts are fed by nerves emanating from corresponding vertebrae, he formed the previously mentioned hypothesis that remains the basic point of friction between chiropractic and the world of medicine.

Oddly enough, this animosity took a long time to develop. Whereas most radically new ideas meet with immediate scorn and rejection, chiropractic hardly raised an eyebrow when it was introduced to the American public in the 1890s. One reason for this is that Palmer himself was only a generation or so removed from many eminent physicians who had viewed the spine as the possible seat of innumerable ills. The idea of spinal manipulation wasn't all that radical. But the main reason for the ho-hum response to Palmer’s claims was the fact that almost simultaneously to his “discoveries" were the breakthroughs in bacteriology, diagnosis, and surgery. In the excitement of finding medicinal cures for fatal illnesses which had long plagued mankind, this new method for relieving backaches was like a bothersome child tugging at the coat of science.

Members of the medical profession in the first third of this century were determined to focus their attention on infectious disease and similarly urgent problems. It wasn’t until the 1930s that they became interested in physical medicine and rehabilitation. By then, chiropractors had achieved a foothold in the climb toward popular acceptance. People assumed that since physicians had largely ignored back problems in their haste to attach themselves to the bacteriology bandwagon, chiropractors must logically be considered specialists in the area of spinal therapy. Even today a great number of physicians have little interest in treating back ailments, since exact diagnosis is often as difficult as it is expensive.

Too many M.D.s are willing to claim psychological problems or poor physical habits as the source of back ailments, prescribing painkillers, tranquilizers, or relaxants instead of pinpointing the trouble more precisely. Orthopedic specialists readily admit that the ordinary doctor is not always able to diagnose and treat back problems successfully. But while they accept the chiropractor’s capacity for handling minor joint and spine subluxations, they are adamant about his inability to determine more serious, elusive disorders such as spinal tumors. In such cases, the orthopedics claim, chiropractors may manipulate the patient in the usual way for months, while a potentially fatal trouble spot goes unchecked. The specialists ascribe this alleged inadequacy to what they believe is the chiropractor’s inferior education, medical training, and overall preparation for dealing with severe back ailments.

This allegation may not be as factual today as it once was, but it is relevant to note that educational standards at chiropractic institutions in the past were notoriously low. For example, in 1945 a person could still receive a mail order Doctor of Chiropractic degree from a Chicago-based college for $127.50. Similarly, other colleges of chiropractic were turning out diplomas to students who hadn't even finished high school. A survey conducted in 1964 by Dewey Anderson, who was then director of education for the American Chiropractic Association, showed that instructors at the various chiropractic schools were teaching basic science courses without having had any relevant advanced training in those subjects. Many of these teachers were so insufficiently prepared to instruct that they merely verbalized the texts supplied by the colleges, resulting in a level of education far below that of most post-professional institutions. Some doctors have gone so far as to indict the four-year chiropractic college curriculum for providing an educational environment below that of the average junior college.

The elitist attitudes of many physicians notwithstanding, it is true that chiropractic students up until a few years ago had for the most part never experienced anything more demanding than a high school biology course, and of those who finished high school, few were even in the top half of their graduating class. While such students could not be expected to do well in a professional college program, most were able to obtain a chiropractor’s license with relative ease.

By contrast, a medical student must traditionally have not only the grades worthy of entrance to a good four-year college, but must also receive exceptional marks in his or her university courses. As any pre-med student will grudgingly admit, even a straight “A” average through all four or five years of lower and upper division science instruction is no guarantee of admission to a medical program such as that offered locally at the University of California at San Diego. If, however, a person does qualify for entrance to such an institution, he or she must sweat out four years of medical school, followed by three or more years of hospital residency.

The physician’s subsequent affiliation with a hospital provides a means of reinforcing and augmenting his or her previous training through conferences, discussions, and experiences shared with colleagues, as well as direct experiences with patients. The chiropractor, once licensed, almost invariably works alone.

The question of insufficient education is, understandably, a touchy one for chiropractors, since the inference is that preparation for a chiropractic career is roughly analogous to attending a trade school. Implicit in the physicians' stand is the belief that health is something much too dear to entrust to someone who has not had to meet the rigid educational requirements of the average general practitioner.

In spite of all this deprecatory evidence, there are two important reasons why chiropractic education should no longer be made an issue in the chiro-medical imbroglio: first, the educational system at chiropractic colleges has changed immeasurably for the better in recent years.

Although the enrollment of 2,100 students at the Palmer College of Chiropractic (the world’s largest) in January of 1975 still included 550 students whose previous instruction was limited to a secondary education or its equivalent, it is significant that those students were seniors scheduled to graduate later in the year. Of the remaining students, all had at least one or more years of college education prior to Palmer, and 416 held university degrees. Today a student wishing to enter a four-year chiropractic college must have at least two years of college.

Secondly, the chiropractor’s very raison d’etre is to provide an alternative to the highly drug-oriented services of the physician; to prove that expertise in chemistry and deftness with a scalpel are not automatic guarantees of an ability to cure, much less prevent, illness. In that light, two or more years of higher education and four years of applied study in chiropractic seem entirely adequate preparation for a practice that focuses primarily on manipulating only one area of the body.

But possibly the most telling development of the last five years that stands to substantiate, at least on the surface, the claims of chiropractors on behalf of spinal manipulation, is the gradual assimilative techniques into the physical therapy of orthopedic specialists. These physicians, while ridiculing chiropractic on one hand, are learning its applications at the same time. Not at chiropractic colleges, but at a series of weekend seminars, where they learn “textbook” manipulation methods. This situation has given chiropractors an excuse to return some of the abuse that has been heaped upon them by doctors for so long, and brings the issue of adequate training into perspective. As one local chiropractor put it, smiling, “these 30-day-wonders attend a few weekend seminars on manipulation, then ‘train’ on their patients. They figure that they can learn in a matter of days or weeks what it takes us four years to become skilled at. Many of their patients end up visiting a chiropractor just to undo the damage done by a ‘specialist’ who has strayed from his specialty.”

Predictably, the orthopedic surgeons use exactly the same words to describe the situation in reverse. They claim that more and more patients are suffering debilitating injuries at the hands of chiropractors who don’t exercise enough care in manipulating a person's spine. According to a specialist in La Jolla, these injuries are often “appalling," and can only be corrected by an orthopedic surgeon, either through direct physical therapy (sometimes including manipulation) or by the application of traction.

In view of these contradictions, it would seem likely that one of these parties is not telling the whole truth. Actually, they both are. As in every other occupation, there are members of both the medical and chiropractic professions who would be doing the public a great service by not practicing. There are cases on record to support the claims of both schools with regard to malpractice, making the question of who-does-the-most-damage a moot point. What is important, then, is the distinction between the services offered by each specialist.

Neither physicians nor chiropractors find it easy to allow that the other has exclusive domain in certain areas of health care. Those in orthopedics condescendingly admit that chiropractors can perform simple manipulative tasks that ease muscle strain or joint malfunction, but give them no credit for being able to prevent or cure illness or serious spinal problems. Chiropractors, while currently reticent to prescribe spinal adjustment as a panacea for every disorder, nevertheless find it difficult to admit that their skills are not suited to treating some physical ills that are obviously unrelated to the spine. This is where the chiropractor’s credibility comes under attack.

Through the years, chiropractors have claimed that spinal adjustment can cure or prevent everything from heart disease to bedwetting. Although there is no proof that this is not the case, there is. of course, little documentation to substantiate these claims. Physicians indicate the probability that certain symptoms of physical impairment that disappear following spinal manipulation over a period of time are actually attributable to other minor disorders that would eventually right themselves anyway. For example, pain that arises from restricted movement in a spinal joint is usually confined to that particular area. But there are some cases in which the pain is referred to another part of the body, say, the chest. While the pain is very real, its location only mimics actual angina. Some chiropractors naturally assume that the pain is heart-related, and that when their manipulations relieve the discomfort, they are actually treating the person’s coronary troubles. Small wonder that medical people find so much amusement in repeating the claims of many chiropractors. Fortunately for them, most chiropractors these days are a lot more modest about their achievements, without losing sight of the general principle that dominates their work; that proper spinal alignment is essential to good health.

Although chiropractors have, of necessity, toned down their claims, this should not be misconstrued as surrender to the “superior” forces of the medical establishment. On the contrary, it is a step toward the acceptance within medical circles that has eluded chiropractic for so many years. By doing away with the truly outlandish declarations and centering instead on more realistic therapeutic goals, chiropractors have actually managed to sway many physicians away from their staunch anti-manipulation stances.

The official A.M.A. line is still critical of chiropractic in general, but there are signs that the medical world is looking more favorably upon chiropractic as a means of treating back-related problems. Some M.D.’s, in fact, have begun to send certain of their patients to chiropractors for adjustments. In just as many cases, chiropractors refer some of their patients to medical doctors, often developing a cooperative relationship with the M.D.’s in which each professional respects the other’s skills. This mutual respect, needless to say, does not extend to voicing public approval of a competitor, as witnessed by an anecdote concerning a speaker at a national medical convention a couple of years ago.

It seems that an orthopedic surgeon was bothered by pain in his lower back during much of the convention. Braving discomfort, he made his scheduled appearance as a vociferous critic of the “chiropractic cult," drawing loud applause from the assemblage of physicians, who he entertained with a harangue in which he denounced every important claim by chiropractic proponents. He received a standing ovation from his colleagues, and while they stood cheering, he made his way quietly out the side door of the hall and down the street to a chiropractor for an adjustment on his aching spine.

CONCURRENT WITH THE modest yet noteworthy gains made by chiropractic in striving for medical recognition are the tremendous increases in patronage over the last few years. Official estimates show that approximately nine million Americans are treated annually by the 20,000 or so chiropractors who practice in this country. Indeed, popular support has been instrumental in defeating the occasional attempts made by organized medicine and the Public Health Service to discredit chiropractic. Time and again, proposals will be put forth by “experts" representing the medical establishment, aimed at turning Congress' head away from official acceptance of chiropractors as “legitimate practitioners of the healing arts.” Time and again, these proposals are answered by a deluge of letters to government leaders which swear by chiropractic and its healing ways.

But what is especially disturbing to the medicos is that a broad-based popular appeal brings with it the proliferation of word-of-mouth stories that serve to lend credence to chiropractors’ claims. Most of us have heard at least one person’s description of how he or she spent a great deal of time and money on orthopedic specialists, only to find relief in a chiropractor’s office. The irony is that the “scare stories,” once pertaining only to the “horrors" one inevitably encountered in a chiropractor’s office, are now pointed in the orthopedic surgeon's direction, deservedly or not. Apparently, the only thing more frightening than having your bones “popped" or your neck twisted, is having to go “under the knife."

The proponents of chiropractic can always count on the fear of surgery to bolster their already burgeoning clientele. Fortunately for chiropractic, the number of satisfied patients far exceeds the list of those who, despite adherence to a strict chiropractic regime, must surrender to surgery after all. Statistics show that only about two percent of , people with back problems submit to surgery. While this proves that orthopedic surgeons are not the knife-wielding maniacs some people assume them to be, it also indicates the success of physical therapy in treating back ailments; physical therapy that increasingly involves direct spinal manipulation.

To illustrate the kind of free advertising that satisfied patients engage in on behalf of chiropractic, consider the case of a San Diego woman whom I spoke with about her long history of back trouble. Joan, as I will call her, twisted her heel on a door mat several years ago, “slipping a disc" in the process. The pain grew unbearable, and since chiropractic was not an automatic alternative at that time, Joan was operated on by a reputable orthopedic surgeon. Recuperation was long and costly, and never really complete.

After almost a decade of suffering with chronic discomfort, a condition her surgeon decided was irreversible due to the initial injury, she arrived at a point where a crucial decision had to be made; either she submit to surgery again, this time to “fuse" the renegade vertebra to an adjacent one. or visit a chiropractor for the first time. The choice was a painful one to make. On the one hand, she could risk, according to her doctor, confinement to a wheelchair or even death if she delayed a second operation. On the other, she knew nothing about chiropractic, and could scarcely imagine being manipulated in her condition. Joan opted for chiropractic treatment, and today, several years later, she is mobile and almost completely free of pain.

If one specific incident doesn’t necessarily prove the effectiveness of chiropractic treatment, it is still generally acknowledged, even by orthopedic specialists, that some people are helped a great deal by the method. Why.then, if chiropractic has proved itself beneficial, do orthopedics yet refrain from accepting it outright? Why not welcome it gladly into the hallowed halls of healing? The answer lies, to a great extent, in medicine’s contention that chiropractic is successful not for scientific, but for psychological reasons. Any benefits derived from spinal manipulation, other than the easing of discomfort due to simple subluxation, are said to result from the “placebo effect.”

The placebo effect is also evidenced, however, when surgeons perform “sham" operations on people convinced that only surgery can remedy their afflictions, or when a doctor administers a “dummy” pill to a pregnant woman to rid her of her nausea.

AT A TIME when it would seem a good idea to maintain a low profile with regard to new methods of treatment, chiropractors are now experimenting with something called “spinal touch." This new development, once examined by orthopedic specialists, will probably be considered the ultimate example of placebo effect healing.

Spinal touch, which is related to acupuncture, “laying on of hands.” and other “touching treatments.” is administered by lightly touching 134 points on the buttocks, spine, skull, abdomen, etc. According to the spinal touch theory, the sacrum, a solid bone formed by the fusion of five vertebrae in the lower spine, is the center of the skeletal system. As such, it must at all times be properly balanced in its relationship to posture and the pull of gravity.

When the sacrum, or the muscles surrounding it. are imbalanced, the pasture suffers, placing unnatural strain on the body. The belief is that spinal touch enables the sacral muscles to relax, and thus regain their proper balance, due to the soothing emission of natural electricity from the tips of the fingers.

Even chiropractors are somewhat skeptical of spinal touch, until they undergo an experience in which a patient actually seems to benefit from its application. Such was the case with one local chiropractor, who related the following story: A young woman had undergone back surgery that did not relieve her of a persistent pain. She was referred to this ( chiropractor, who applied the usual manipulative techniques, to no avail. Eventually the pain extended down from her lower back into her legs. Continued treatment didn’t seem to be working, and subsequent hospitalization (at the suggestion of the chiropractor) found no pathology which could have been causing the pain; no muscle or nerve problems or disc displacement. She was released from the hospital with only a back brace as her ongoing therapy.

The pain by now was so severe that she could only get out of bed twice daily. At this point', the chiropractor decided to try spinal touch, in which he had recently finished instruction. After a few sessions of spinal touch, the woman stayed out of bed for an entire day, and after a few more treatments she was able to take her children to Sea World for the day. Eventually she got a full-time job, where she is still employed. Spinal touch for this chiropractor is no longer the subject of his skepticism.

Still, one would expect that the practice of spinal touch would have elicited a much stronger response than it has thus far. There has been no public outrage, no large body of physicians claiming that chiropractic has finally sown the seeds of its own destruction. Instead, chiropractic seems buoyed by recent legislation aimed at recognizing it as a healing art.

In 1973 chiropractors won the right to render some of their services under both Medicare and Medicaid. Not long after that, Mississippi and Louisiana, the last two holdouts among the 50 states, established a licensing system for chiropractors practicing in their territories. But the real triumph came in August of 1974 when the department of Health, Education, and Welfare recognized an accrediting agency for chiropractic colleges. This meant that these colleges would be considered national institutes of higher learning, a huge step on the road to open acceptance by the major medical-federal powers.

Chiropractors, being human, obviously feel a certain satisfaction with the legislation that has brought them new recognition. The “purists." however, relish a different kind of triumph than that experienced in Washington, D.C. The true believers in chiropractic, though delighted by the added respect afforded them by official governmental accreditation are more concerned with the welfare of their patients.

A progress report on the young man alluded to early in this article shows him lying face-down on a special manipulation table, readied for a complete spinal adjustment. He has been prepared for manipulation by lying on his back on a pad that emits rhythmic, mild electrical impulses. The impulses stimulate the back muscles to contract rhythmically, and after about fifteen minutes of this the muscle spasms that normally accompany subluxation have pretty much disappeared.

Now that he is in position to be manipulated, the chiropractor searches with sensitive fingers for any misalignments of the neck and/or spine. There are the usual weak spots, caused by improper sitting and posture, but a couple of especially bad subluxations just above the collarbone. The young man fights the urge to yell as stiff, sore muscles are plied, and vertebrae are thrust back into place. The going is rough, but only because of the relative severity of his subluxation.

After several minutes of manipulation, his initial visit is over and he walks, cautiously, toward the waiting room door. Testing his new mobility, he stoops painlessly, albeit a little awkwardly, to pick up a magazine which has fallen from a wall rack. It is a well-known national magazine, and features on its cover a world-famous surgeon in full operating regalia. The other patients in the room can’t possibly be expected to comprehend the broad smile that creases his face as he replaces the magazine and walks confidently out the door.