Chiropractic Identity Crisis Pt 2

What do adjustments actually do? This is something that I think we have to be able to answer for our patients if we want to be able to inspire confidence in them, have them understand what we're doing. But the truth is my experience, most chiropractors cannot answer that question. What does an adjustment do? And if you don't know and you can't articulate it clearly, your patient won't. They will never really understand what you do. That will lead to early dropouts that lead to them thinking you're doing different things like putting bones back in place and that kind of stuff. And it can just lead to a lot of frustration when you and the patient keep missing each other and you don't realize why. So I think most chiropractors can't articulate this as clearly as they would like. Yes, there are the traditional vitalistic chiropractors. In part one, I talked about why I think understanding, having answers for these questions and forming part of an overall philosophy or chiropractic why is important. I also said I'm not really going to go there in terms of traditional chiropractic and vitalism. It's not how I practice, it's not my wheelhouse. I'm not going to go and knock it. I'm just going to talk about what I do, which is something different. So from my experience, most evidence based or evidence informed chiropractors can't really say what an adjustment does. We know what other people say it does and we know that we don't necessarily agree with that. We don't know if that's true, but we don't really explain what it is that we're doing other than getting the spine moving better. And if you've graduated from college in the last five years, almost certainly you don't because the colleges don't necessarily teach this stuff so much. Now there's many other things they're teaching, not knocking the colleges. They have a tough job. I'm not an educator, so I haven't been in their shoes. But I will say if you don't know how to explain what adjusting does and what we do as chiropractors, then you're gonna have a very, very tough time in practice. So I'm going to share what I understand. A lot of mine has formed by Leonard Fay. If you don't know Leonard Fay is like old granddad of evidence based chiropractic. He was one of the original faculty at AECC when it was set up like six decades ago. He's been an absolute pioneer in the profession and very much an evidence based chiropractor. So I've learned a lot from him and I found a lot of the research that actually I wasn't taught at uni that helped me to better understand what we do. So I'm going to talk about this. This is going to lose some people, this is going to trigger some people because I'm going to talk about things that not everyone in my circle agrees with. I'm not going to be sharing referen preferences and all this kind of stuff here. If you really want that stuff, you can message me. But to be honest, my point here is just to show you what I believe so it can get you thinking about what you believe. Because when I can explain this to patients, they really understand things, they build a lot more confidence. So pick and choose if you want to take some of this. If you don't, that's absolutely fine. What we need to do when we're talking about chiropractic, to me we are talking about restoring normal function to joints. Yes, we might influence the muscles and the nervous system. I'm not knocking those. But what you can definitely say a chiropractic adjustment is it influences the joints. Okay, so many of you will have learned this if you graduated like you know, 15, 20 years ago or even longer ago than I did. But a lot of the more recent one might not have understood this or may have learned it in year one at uni. So when we talk about motion in a joint, we need to look at what is, what is aberrant motion, what is not helpful motion. And you've got three different categories of motion for joints. You've got active motion, like what can I do myself? Then you've got passive motion. What can somebody else do to me? If the joint isn't being moved by its own muscles, then you have accessory motion motion, which is the motions that the joint can't do itself. So I won't go into the weeds here for those of you who know. But essentially if I think of long axis distraction on my knuckle, that's an accessory motion because I can't do that with my muscles. Same with rotation, same with AP or lateral shear as well. An accessory motion, it turns out, really, really matters for joint health. And that's what I believe we're measuring as chiropractors. So when you have good accessory motion and the joint has that in all planes, it means the joint can load share properly. It means as it's loaded, it can share that load around. It can Move and it can adapt. It's got some spring, basically, it's got some flexibility. That's what we want. If a joint loses accessory motion, you can do all the work you want on active and passive motion. You can do long lever techniques, you can do stretching, pnf, all these kinds of things. But if you don't restore the accessory motion, the joint cannot load share properly. And we know that that is a causative factor in long term pain, dysfunction and degeneration. Link between pain and degeneration isn't that solid. We know, but they are both affected and both caused in part by aberrant load sharing. And that's what we detect with motion palpation. When the patient is seated and we assess the motion, we take it to enrage. We put a little challenge. We're assessing that little extra joint play. We're looking for that accessory motion and we're looking for, does this joint move in all three planes? That's why I'm a big believer in motion palpation. Now, I know motion palpation has got knocked a lot in the research. You know, the idea that you get two chiropractors and they both palpate the same patient and write down the listings or write down which segments they feel are stuck on its own, we don't agree very much. And that's true. However, something I learned from Len Faye, it doesn't matter that much because two reasons. One, when you allow them to check with the patient, suddenly we agree more. When I say to a patient, how does that feel tight there. How does that feel to you? When the patient goes, yeah, that's stiff, Suddenly we get more accurate. Also, all chiropractors will generally agree on what is the most stiff section of the spine, even if they don't agree on the specific vertebra. You know, we can all take a patient and we can all be accurate in terms of, okay, is it the CT or the lumbar sacral? That's tighter. So we'll all find the right area and the patient can help guide us in a bit. And most importantly, we know that when we adjust somebody, multiple levels get adjusted. Multiple levels will often cavitate. What sounds as one, cavitation often is two, three or four. And you can't move one segment on its own. You're moving an entire region of the spine. We also know that regardless of what the practitioner is feeling, if you blind practitioners, you have somebody, patient comes in and let's say I palpate them. And I feel that to me, the L4, process feels stuck. Then they go and see somebody else. Somebody else does something, they adjust that area. Let's say patient comes back in. If I palpate and I go, yes, I feel that's moving better, that is associated with a better outcome, regardless of what the other practitioner did. So in practice, what this looks like is I adjust. Sorry. I palpate a patient, I feel something stuck. I don't know what it is. Maybe it's two, three, Maybe it's three, four. Who knows? Doesn't matter. I'm going to adjust them. I'm going to free up multiple segments. In all likelihood, then going to recheck. If what I feel has improved, we know that is associated with better outcomes. So I go, good. Well done, Chris. That adjustment worked. Let's move on to the next thing. If I palpate it and it isn't moving, we know that. Okay, that didn't work. Now we could argue about which tissues are restricted or what levels. Doesn't matter. Because I can't influence a single level. My adjustment is going to move multiple ones. So I'm going to try that again. And this is what it really takes to develop true mastery in a skill. You know, to actually master something, you need to be challenging yourself, and you need to get immediate feedback. What most practitioners do is we leave it a week or two weeks, we palpate somebody, we go, I think this needs adjusting. We adjust them, go, right, come back next week, and then we recheck. There's an entire week with the patient doing loads of different things. How do we know if it worked or not? So you have to immediately recheck. I'm rechecking patients, I'm setting them up and laying down multiple times, because we know that is what leads to actually mastering a skill over time. The research shows that you pick some random practitioners who've been doing this for a while, they don't seem that accurate. That's true, but that's not necessarily reflecting what master is. Stuart McGill says this as well. He says, yes, palpation on average, isn't that great. He goes, but I'm not interested in what an average palpatia can do. I want to know what a real expert can do. And I personally believe that we should develop true expertise in that. So to me, motion palpation is allowing us to find where an issue is, and it's allowing us to tell if our treatment corrected that issue. Whether we label it as one level or another doesn't matter to me. So that's essentially what we're doing. When we adjust a patient, we are restoring that normal motion where, you know, we're stretching out the ligaments, we're freeing up in that range. That's what manipulation does. Whether you call it manipulating or adjusting, I don't care. Really stretch the capsular ligaments and the other tissues to normalize that joint play. If we feel it's moving better, great. So that's something that we're doing. The other thing is, in terms of cavitation, cavitation doesn't seem in the research to be linked to better outcomes overall. I will say, in my experience, patients who experience cavitation tend to get instant effect. It's quite good for patient trust. I tell all my patients that the two things we know from decades of research is one, it doesn't really matter if you get a pop or not, and two, it doesn't matter what I tell you. You won't be happy if there's no pop. We have a little laugh, and that's okay. It does seem like if you get a cavitation, there is more afferent input back into the brain that could possib improved motor control. Now the brain is even more aware of what's going on there. Maybe the jury's still out on that. I don't really know. I'm not overselling like neurological super effects of the adjustment there. So that to me, that's what we're doing. And we need that immediate feedback loop. When you get that, it's really good for your own confidence and the patients, because you can show them and get them to feel in real time the differences you're making. Because remember, if the patient's feedback is factored in, that improves accuracy. If the patient says, oh, yeah, that does feel stuck, and oh, that does feel better, that's better for results. It's also better for building trust as well. But you've got to do that test, treat, retest, this sort of like pop and pray approach that most of us use, and I did for quite a while. That's not mastery. And I did that for many, many years. It didn't really help me build confidence in my adjusting, didn't really help me build confidence in what it was we were actually doing. So that's my philosophy of adjusting. If you will use motion palpation, yes, it may not be that accurate, but no one's got a better idea. And you can factor other things to make it a lot more useful. It's accurate enough for me to determine if whatever I did is likely to have a beneficial effect. I'm happy with that. And the adjustment is restoring that normal motion. Now, are there other effects to the adjustment? Yes, of course. There are neurological effects to it as well. I just don't really go into that because to me, I don't think we're there on the research to be able to say categorically this will happen or that happen. It seems to some people there's influences on the sympathetic nervous system. There's plenty of cases out there of people improving in different areas other than where they were adjusted. I'm sure that's possible. I've seen that. I've seen patients get responses to things like Crohn's disease and asthma in my practice, absolutely fine. I don't believe we can predict that reliably. I think it is certainly the way I practice. It's a pleasant byproduct. It's an unusual side effect. To care. That is great and I'm interested in, but I don't make any claims to that. So I personally build my practice on restoring motion, improving the motion through the spine there. I don't do it saying, I'm going to improve your overall wellness. I'm going to cure systemic illnesses or anything like that. I don't choose to practice that way. I'm improving the mechanics, I'm improving the load sharing. I'm getting everything physically moving healthier. Because if you do a really good job of that, you'll see you can change lives doing that without all the hype. One analogy I found really helpful with this as well is, you know, when people are, oh, you can't feel millimeters of difference below the surface, like this kind of stuff, I would say, well, you can feel the difference in a cricket ball and a tennis ball very easily. When you're blind, even a cricket ball and a cross ball, you hand them to somebody, little bit of movement, that little bit of tactile stimulation, you can certainly feel that. So when it's the difference between this is solid on the segment, it's not moving, and there's a bit of motion here, I'm confident. I can feel that. I'm confident most people can feel that. Yes. You get better over time. Factoring the patient's feedback as well, that's really key. But the idea that you can't feel the stuff, it's just nonsense. I think it's often an excuse made by people who either aren't very good at it or just haven't been in the trenches and haven't done the, you know, actually practice this enough to know what it's like and get that hands on experience there. So I believe we can definitely detect joint stiffness. I believe we can definitely correct that and we can definitely have a good idea whether that's worked or not. The only other thing I would say at this point is that I also believe we have to be masters of treating extremities because I've seen many, many, many cases when I started looking and only when I started looking of cases where particularly chronic issues in the spine were being at least in part driven by an extremity issue. So yes, I believe we should be experts in the spine. That's our cultural authority. Our cultural authority is also in adjusting and I think that's really, really key. However, I also think we have to be able to assess the entire kinematic system top to toe, because these do affect each other not predictably and not reliably every time. But if someone, if you, if a chiropractor tells you that adjusting the foot can't ever help back pain, that just tells me you've never looked at enough feet, you haven't tried adjusting them enough. Because I didn't and I didn't see it. And then when I started and I started making changes, I realized, wow, that makes a difference. So that's one of my other whys, one of my other truths, so to speak. I realized this video, there's a lot of people are going to disagree with it. That's fine. I'm not really looking to get into a debate with this. I'm not looking to produce like a coherent PhD thesis and evidence backed and all of that. This is just what I see. I'm sharing it because I think it might be sort of get you thinking about what you think we do and what you see in practice and what your explanations for what an adjustment actually does are for patients there. So this is part two, part one. We talked about the patient centered side of things, the ethics of it. Now we're talking about the adjustment. Next one, we're going to talk more about our broader professional identity. So how knowing these things can become part of a professional identity that you understand and why that clarity of what makes you different from other practitioners is really, really key to communicating that to patients and getting their, their trust essentially. But also really key to you developing your own inner confidence, your own sense of self and your own satisfaction in this career. Because I believe chiropractics, it's the best career I ever could have chosen. I absolutely love it. But if I didn't have a professional identity, I wouldn't be able to feel that way. So keep an eye out. I'll release that in the next few days. Any questions or comments, just pop them below.