History of the Documentation of the Subluxation: Does the solution to our future lie in our past?

By John Maltby, DC

​ No matter what you think of BJ Palmer, he seems to have been on to something.  In 1938, the public’s view of Chiropractic was at an all-time high.  Now, with the most recent Gallup Poll numbers, it appears that we have hit an unprecedented low.  The truth about the 2016 Gallup Poll, those touting it’s value are hiding is shown clearly in the infographic below.  So what is it BJ knew in 1938 which we may learn from today?  

​Many years ago, while a student at Palmer, I stumbled into a room in the basement of Palmer College. I found boxes of patient files from the BJ Palmer Clinic from the 30’s and 40’s.  What became obvious is that BJ knew and valued science.  I found pre and post x-ray, and a variety of other scientific measures used to test patients pre and post adjustment. He appeared to know that if we could prove through scientific means that subluxation correction was measurable, that we would have what he called “incontrovertible evidence”.  In 1938 he wrote:

“Medical contention is:  If a patient gets well under chiropractic care, it is a matter of OPINION.  In the BJ Palmer Clinic, we go “scientific” with a vengeance.”  They DEMAND LABORATORY PROOF.  These things we set out to prove in this Clinic by the use of scientific instruments, with scientific means, in a scientific manner: proofs which are the last word and will be incontrovertible.  
BJ Palmer, 1938

​Gallup Poll: Americans Have Low Opinion of Chiropractors' Honesty and Ethics
Medical Doctors, Five Other Health Occupations Rate Higher

​Is it possible that in 1938 BJ was warning us that the world would be more impressed by data and science than philosophy?  We all know our philosophy is what separates us from other professions, but in reality, is it what patients and the public are most impressed with? We’ve tried sports endorsements, extensive practice management approaches, well thought out scripting and patient education campaigns, and are still viewed, according to Gallup (and our statistics) as the last choice of the public when it comes to healthcare.  Although BJ was eccentric, he may have had a wisdom we need now more than ever. When I ask doctors what they consider objective data, they respond “visually assessing range of motion”.  Really? What made me extremely aware the power of BJ’s desire for more science in the profession was when I took my vehicle to the auto mechanic for repair.  He said “Your wheels our out of alignment, and need an alignment or your tires will wear out.  

In my head, I was thinking “sure I do….you’re just trying to sell me your services”. Then, he pulled up a computer generated graph showing me the wheels were out of alignment.  Did I have a choice? He provided objective proof of the problem, and I said: “Ok, fix it”.  Is it not obvious that if we had the equivalent of the mechanics alignment tool, we would have so much more credibility as viewed by the public?  Well we do.  We just fear embracing it.  There are many reasons for these fears, including whether or not the technology will support our beliefs about our techniques.  We just have to get over them, as the sooner we embrace technology, the quicker we will start seeing a higher percentage of the public, and helping more people. 

​What is the worst thing that can happen does not support our beliefs about the effectiveness of our techniques?  We will become better, more effective doctors by using this feedback to hone our skills, and stop seeing patients disappear for reasons unknown.   There is a technology which has been instrumental in not only winning the respect of the public, including attorneys, but ensuring that we as Chiropractors are seen as the experts in spinal health.  I truly want to see a day when Surgeons respond to each and every patient buy sending to the Chiropractor first.  To achieve this dream, we need BJ’s mindset, as everyone including surgeons are data driven.  Last year, I utilized this tool for a chiropractor in an auto accident.  This case became so high profile that the insurer hired the most expensive expert witness in the US as my opposition.  He was a UCLA Professor and “Super Doctor”. The attorney wanted to fold at $25K solely based upon the fact that this MD’s opinion would overshadow mine.  I said “Trust me.  In our data driven world, data is indisputable and easily wins over the status or rank of those offering medical opinions. She trusted me, and the case settled for over $750K. The patient won, the attorney won, and now I receive constant referrals from top notch attorneys.   

The tool I used is a new device which increases sensitivity of range of motion by adding muscle guarding to the measurement, and is recognized as the Gold Standard by the AMA.  .  It is known as DynaROM as it measures both range of motion and muscle guarding simultaneously.  Why?  Because over 50% of soft tissue cases have normal MRI and normal Range of Motion.  The principle is simple: When we bend into flexion, there is a reflex established in the ​scientific literature as the flexion-relaxation response. ​

Essentially, individuals not in pain, hang off the ligaments in flexion, and muscles shut off. We cannot control this reflex.  Those in pain experience a severe degree of muscle guarding in response to pain in this motion.  It takes the same time as Range of Motion, but has the ability to more accurately assess for injury.  More importantly, this paradigm shift protects us from handing insurers ammunition to use against our patients.  How common is it to see normal ROM with muscle guarding and pain?  Yet, we send in our range of motion data, which provides insurers the objective proof the patient needs no further care.  This clever trick on the part of insurers is addressed so effectively with DynaROM that they questioned the validity of it all the way to the Supreme Court in Florida, where the insurers lost and the tool was established as an “approved diagnostic device” by the State Legislature.  This landmark case in chiropractic, protected our rights to see PI patients; the patients that need us the most!   
 “Are you mechanistic or vitalistic”? seems to be my number one question with this paradigm presented. My response has always been “no”.  Why?  The reality is that it is a mix of both, and the last thing we need as a profession is to add more fuel to anything which divides us as a profession.  Such silly arguments have been used in the past to create divides which the world uses against us to make us appear undefined and without identity.  Perhaps BJ knew science could provide the proof we need to establish our identity once and for all. Those who reject the integration of science into our profession simply fear finding out that their beliefs are limiting them, with a world of new possibilities available to them through a minor shift in mindset. A great benefit is that objective data helps them fine tune their skills, making them better doctors.  We live in a data driven world.  It is time as a profession to embrace this, and not fear it.  The worst that can happen is that we are perceived by the public as the knowledgeable professionals we know we are.  We just must show it. Heinlein said it best: “If it can’t be expressed in figures, it is not science; it is opinion.”  BJ may have been eccentric, but he may have also been right.

References:
 1. Geisser, ME, Ranavaya, M, Haig, AJ, Roth, RS, Zucker, R, Ambroz, C, Caruse, M, A Meta-Analytic Review of Surface Electromyography Among Persons with Lower Back Pain and Normal, Healthy Controls. Journal of Pain, November 2005; Vol. 6, No. 11; pages 711 to 726. 
2. Ambroz C, Scott A, Ambroz A, Talbott EO. Chronic low back pain assessment using surface electromyography. J Occup Environ Med 2000;42:660-9. 
3. American Medical Association: Guides to the evaluation of permanent impairment, 5th edition. 
​4. Richard W. Merritt, DC vs. Department of Health and The Florida Insurance Council. (Case No. 04-1149RX).case details at www.dynarominfo.com.