Chiropractic - History
Philosophy
| THE TESTABLE PRINCIPLE | THE UNTESTABLE METAPHOR | |
|---|---|---|
| Chiropractic Adjustment | Universal Intelligence | |
| ↓ | ↓ | |
| Restoration of Structural Integrity | Innate Intelligence | |
| ↓ | ↓ | |
| Improvement of Health Status | Body Physiology | |
| MATERIALISTIC: | VITALISTIC: | |
| — operational definitions possible | — origin of holism in chiropractic | |
| — lends itself to scientific inquiry | — cannot be proven or disproven | |
| taken from Mootz & Phillips 1997[1] | ||
Traditional and evidence-based chiropractic belief systems vary along a philosophical spectrum ranging from vitalism to materialism. These opposing philosophies have been a source of debate since the time of Aristotle and Plato. Vitalism, the belief that living things contain an element that cannot be explained through matter, was responsible for legally and philosophically differentiating chiropractic from conventional medicine and thereby helping ensure professional autonomy.[2] Chiropractic also retains elements of materialism, the belief that all things have explanations, which forms the basis of science. Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining.[1]
The chiropractor's purpose is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being of the person as a whole.[1] Principles such as holism, naturalism, therapeutic conservatism, critical rationalism, and thoughts from the phenomenological and humanistic paradigms form an important part of the philosophy of chiropractic."[3]
Chiropractors can adopt or share vitalist, naturalist, or materialist viewpoints and emphasize a holistic, patient-centered approach that appreciates the multifactorial nature of influences (i.e. structural, chemical, and psychological) on the functioning of the body in health and disease and recognizes the dynamics and interplay between lifestyle, environment, and health. This holistic paradigm is also blended with a biopsychosocial approach, which is also emphasized in chiropractic care. In addition, chiropractors also retain naturopathic and naturalist principles that suggest decreased "host resistance" of the body facilitates the disease process and that natural interventions are preferable towards strengthening the host in its effort to optimize function and return to homeostasis.[1] Chiropractic care primarily emphasizes manipulation and other manual therapies as an alternative than medications and surgery.[4]
Chiropractors also commonly use nutrition, exercise, patient education, health promotion and lifestyle counseling as part of their holistic outlook towards preventive health care.[5] Chiropractic's claim to improve health by improving biomechanical and neural function by the manual correction of joint and soft tissue dysfunctions of the neuromusculoskeletal system differentiates it from mainstream medicine and other complementary and alternative medicine (CAM) disciplines, but is also rooted, in part, in osteopathy and eastern medicine interventions.[3] All chiropractic paradigms emphasize the spine as their focus, but their rationales for treatment vary depending on their particular belief system.
The philosophy of chiropractic also stresses the importance of prevention and primarily utilizes a pro-active approach and a wellness model to achieve this goal.[6] For some, prevention includes a concept of "maintenance care" that attempts to "detect and correct" structural imbalances of the neuromusculoskeletal system while in its primary, or functional state.[7] The objective is early identification of mechanical dysfunctions to prevent or delay permanent pathological changes.[8]
In summary, the major premises regarding the philosophy of chiropractic include:[1]
- Holism
- non-invasive, emphasizes patient's inherent recuperative abilities
- recognizes dynamics between lifestyle, environment, and health
- spine and health are related in an important and fundamental way, and this relationship is mediated through the nervous system.[2]
- recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body
- appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system
- Conservatism
- balances the benefits against the risks of clinical interventions
- emphasizes non-invasive treatments to minimize risk with a preference to avoid surgery and medication
- recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures
- prevents unnecessary barriers in the doctor-patient encounter
- Manual and biopsychosocial approaches
- strives toward early intervention, emphasizing timely diagnosis and treatment of reversible conditions before loss of functionality
- emphasizes a patient-centered model in which the patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health[2]
- approach of improving health through influencing function through structure primarily via manual therapies
Schools of thought and practice styles
| perspective attribute | potential belief endpoints | |
|---|---|---|
| scope of practice: | narrow ("straight") ← | → broad ("mixer") |
| diagnostic approach: | intuitive ← | → analytical |
| philosophic orientation: | vitalistic ← | → materialistic |
| scientific orientation: | descriptive ← | → experimental |
| process orientation: | implicit ← | → explicit |
| practice attitude: | doctor/model-centered ← | → patient/situation-centered |
| professional integration: | separate and distinct ← | → integrated into mainstream |
| taken from Mootz & Phillips 1997[1] | ||
Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy.[9] Still, significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.[10]
Straight chiropractors are the oldest movement.[11] They adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an Innate intelligence within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies.[12] Their philosophy and explanations are metaphysical in nature and prefer to use traditional chiropractic lexicon (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care.
Mixer chiropractors are an early offshoot of the straight movement. This branch "mixes" diagnostic and treatment approaches from naturopathic, osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of the many causes of disease, and they incorporate mainstream medical diagnostics and employ myriad treatments including joint and soft tissue manipulation, electromodalities, physical therapy, exercise-rehabilitation and other complementary and alternative approaches such as acupuncture. Mixers tend to be open to mainstream medicine.[13] Mixers are the majority group.[14]
Vertebral subluxation
Palmer hypothesized that vertebral joint misalignments, which he termed vertebral subluxations, interfered with the body's function and its inborn (innate) ability to heal itself.[15] D.D. Palmer repudiated his earlier theory that vertebral subluxations caused pinched nerves in the intervertebral spaces in favor of subluxations causing altered nerve vibration, either too tense or too slack, affecting the tone (health) of the end organ. D.D. Palmer, using a vitalistic approach, imbued the term subluxation with a metaphysical and philosophical meaning. He qualified this by noting that knowledge of innate intelligence was not essential to the competent practice of chiropractic.[16] This concept was later expanded upon by his son, B.J. Palmer and was instrumental in providing the legal basis of differentiating chiropractic medicine from conventional medicine. In 1910, D.D. Palmer theorized that the nervous system controlled health:
- "Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations that are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionality—too much or not enough action—which is disease."[17]
The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.[18] In general, critics of traditional subluxation-based chiropractic (including chiropractors) are skeptical of its clinical value, dogmatic beliefs and metaphysical approach. While straight chiropractic still retains the traditional vitalistic construct espoused by the founders, evidence-based chiropractic suggests that a mechanistic view will allow chiropractic care to become integrated into the wider health care community.[18] This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer College of Chiropractic[19]) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College[20]) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.[21][22] A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of visceral ailments that subluxation significantly contributes to, the mean response was 62%.[23] In 2005, subluxation was defined by the World Health Organization as "a lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.… This definition is different from the current medical definition, in which subluxation is a significant structural displacement, and therefore visible on static imaging studies."[24]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11.
- ↑ 2.0 2.1 2.2 Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1.
- ↑ 3.0 3.1 Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1.
- ↑ Hansen DT, Mootz RD (1999). "Formal processes in health care technology assessment: a primer for the chiropractic profession". In Mootz RD, Hansen DT. Chiropractic technologies. Jones & Bartlett. pp. 3–17. ISBN 0834213737.
- ↑ Rupert RL (2000). "A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors, maintenance care: part I". J Manipulative Physiol Ther. 23 (1): 1–9. doi:10.1016/S0161-4754(00)90107-6. PMID 10658870.
- ↑ Rupert RL, Manello D, Sandefur R (2000). "Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II". J Manipulative Physiol Ther. 23 (1): 10–9. doi:10.1016/S0161-4754(00)90108-8. PMID 10658871.
- ↑ Canadian Chiropractic Association (1996). "Glenerin guidelines: preventive maintenance care". Retrieved 2008-02-26.
- ↑ Vear HJ (1992). "Scope of chiropractic practice". In Vear HJ (ed.). Chiropractic Standards of Practice and Quality of Care. Gaithersburg, MD: Aspen. pp. 49–68. OCLC 23972994.
- ↑ Keating J Jr. (2003). "Surveys now and then". Dyn Chiropr. 21 (19). Retrieved 2008-03-24.
- ↑ Healey JW (1990). "It's where you put the period". Dyn Chiropr. 8 (21).
- ↑ Saul F. Rosenthal (1987). A Sociology of Chiropractic. Edwin Mellen Pr.
- ↑ Keating, Joseph C. (2004). Chiropractic History: a Primer (PDF). Association For The History Of Chiropractic. Unknown parameter
|coauthors=ignored (help) - ↑ Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. PMID 9818801.
- ↑ Coulehan JL (1985). "Adjustment, the hands and healing". Cult Med Psychiatry. 9 (4): 353–82. PMID 2934224.
- ↑ Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 23–64. ISBN 0-07-137534-1.
- ↑ Keating JC Jr (1995). "D.D. Palmer's forgotten theories of chiropractic" (PDF). Association for the History of Chiropractic. Retrieved 2008-05-14.
- ↑ Palmer DD (1910). The Chiropractor's Adjuster: Text-book of the Science, Art and Philosophy of Chiropractic for Students and Practitioners. Portland, OR: Portland Printing House Co. OCLC 17205743.
- ↑ 18.0 18.1 Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17.
- ↑ "Palmer College of Chiropractic, General Information". Retrieved 2008-03-24.
- ↑ "Undergraduate and graduate programs 2006–2007" (PDF). Canadian Memorial Chiropractic College. 2006.
- ↑ Kevin A. Rose, Alan Adams (2000). "A Survey of the Use of Evidence-Based Health Care in Chiropractic College Clinics" (PDF). The Journal of Chiropractic Education. 14 (2): 71–7.
- ↑ Samuel Homola (2006). "Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor" (PDF). The Journal of Manual & Manipulative Therapy. 14 (2): E14–E18.
- ↑
- ↑ Template:Cite paper