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Every day physicians see patients suffering from disorders of the nervous system, including those of the peripheral nerves. They have available to them all known physical and chemical methods of investigation, including the recording of nerve impulses in the brain, peripheral nerves, and muscles. Tissues removed at operation and at autopsy are carefully and compulsorily examined by a pathologist, who studies their cellular conditions and correlates his diagnosis with clinical observations and operative findings.
There are indeed cases of obstruction to nerve flow, and of irritations of surrounding tissues. But these result in specific disturbances -- paralysis, muscle wasting, pain, sensory disturbances, vascular disorders, etc. -- but no diseases other than these which are directly related to the function of the nerve in question. Fortunately, these patients are not afflicted with all the ills known to man. The nervous system is important; it has a specific role to play; but it is far from being the sole system of control. To illustrate this truth, a paraplegic woman (whose spinal cord has been interrupted and is deprived of any effect of higher nerve centres) may conceive, carry her pregnancy to term, and give birth to a normal baby.
Orthopedists, whose field is to examine and operate on the vertebral column, frequently encounter the whole range of diseases from benign and superficial inflammation of tissues to malignancies of those bones -- including particularly herniation of the intervertebral disc, a condition which should logically produce obstructions. The vertebral column is treated, and the obstruction, if there is one, relieved. But if other troubles exist, they do not disappear merely with the correction of the vertebral column.
To go further, the causes of a very large number of illnesses are now well known. An immense army of scholars -- physicians, chemists, physicists, biologists mathematicians, indeed men of every scientific discipline -- contribute to this knowledge throughout the world. Their work is subjected to a meticulousness of thought which tries to leave nothing to chance. The causes they have found have been widely varied trauma, poisons, nutritional deficiencies, bacteria, viruses, congenital defects, etc. In each case strict proof has been established between the cause or causes and the disease manifestations. Never has chiropractic theory found a place here. With the greatest indulgence in the world, no place can be found for chiropractic in the practical treatment of disease.
It should certainly not be concluded that medicine ignores or rejects vertebral therapy; but this treatment is far removed from chiropractic, both in principle and in application. Mechanical treatment of vertebrae, whether by manipulation or by traction, is only one of many methods used by physical medicine, which is itself only a small part of the therapeutic armamentarium available to the physician for the treatment of painful conditions of vertebral origin.
The vertebral column, because of its particular structure (numerous articulations, discs which tend to degenerate, etc.), its role as a structural support, and the enormous strains and pressures to which it is subjected, is frequently the seat of pain. The regions most susceptible are the neck and the lumbo-sacral axis.
Certain of these painful conditions may be relieved and sometimes cured by maneuvering the affected region. These forcible passive movements are called manipulations. Manipulation as a therapeutic technique is effective in some cases, but most often is a single element in a program of treatment aimed at restoring the spine to both static and dynamic normalcy. In medicine, these treatments must be decided upon and carried out by a physician; they are never given over to a technician.
The pattern of treatment varies with the clinical problem. Nevertheless, certain general rules should be observed. The first is that the proper use of manipulation depends on accurate diagnosis. Every case of vertebral pain requires a careful history, physical examination and x-rays, and such laboratory tests as may be necessary. It should be borne in mind that:
a) Each pain of vertebral origin, whether local, distributed along the nerve, or referred elsewhere, is not necessarily dependent on a type of spinal involvement susceptible to manipulation. In consequence, a precise diagnosis must be made before it can be decided whether treatment by manipulation is justified.
b) Any inflammation' tumor, or infectious lesion of the spine may first show itself by virtue of a strain or unusual movement. In such cases, it would be dangerous to fail to recognize the true diagnosis.
c) Treatment by manipulation is not an irreplaceable form of therapy. It is certainly tempting because its effects may be rapid and sometimes even immediate. It should be done only if it can be well done. It is better to use other methods than to manipulate badly: "Primum non nocere."
Only if all precautions have been taken should treatment by manipulation be decided on.
Thus, proper manipulation, which aims at relieving pain and improving function, requires sound understanding of the condition for which manipulation is to be done. This also implies complete familiarity with the anatomy and the mechanics of the vertebral column.
Manipulation of the vertebral column may be indicated:
- a) in localized stiffness of the spine, with accompanying pain;
- b) in disturbances associated with the protrusion of a disc;
- c) in sprains of the spine, i.e., traumatic or static conditions in which the disc does not appear to be involved.
These are the Only Three Indications
It is important to repeat here that no form of treatment is irreplaceable. There are certainly cases which can be cured or relieved by manipulation. Very often, however, other treatments can achieve the same result. It is better to refrain from manipulation than to do harm by it, and indications for manipulation must be based on an exact medical diagnosis.
In painful conditions of the vertebral column, traction is also a widely-used form of therapy in medicine. The three principal indications for traction are:
- a) to put the spine at rest by immobilization;
- b) to overcome muscle spasm;
- c) to use sufficient pull to separate bony surfaces.
Thus, mechanical therapy of the vertebral column, either as manipulation or as traction, may be indicated in certain painful conditions of vertebral origin.
It must again be emphasized that in medicine, treatment of the vertebral column is not used to deal with conditions situated elsewhere. Medicine treats disease in terms of its cause.
The Achievements and Uses of Chiropractic
Every worthwhile scientific achievement, no matter how small, pushes back the boundaries of our ignorance, extends the horizon of our knowledge, and puts known facts into new perspectives which lead to further experimental studies. As research budgets climb in geometric progression, limited only by the economic possibilities of each country, we are witnessing an explosion of discoveries which evokes in contemporary man a wondering admiration.
Since the beginning of this century, man has acquired more understanding of nature than he had previously achieved since the Creation. A mere listing of new concepts in human biology added in this century to our store of knowledge would be overwhelming. It is common knowledge that many diseases have been entirely conquered, that others are gradually disappearing, and that surgery in recent years has shown prodigious achievements. It is hard to think of a single area in which progress has not been made. These facts are too well known to bear further elaboration.
Chiropractic was invented in the early days of this scientific revolution. It professes interest in the nervous system, bones, joints, and muscles. Yet it is impossible to cite a single worthwhile scientific discovery, a single contribution by chiropractic to our understanding of the mechanics and functions of these organs. When allusion is made to the progress of chiropractic, it is in terms of increases in the numbers of chiropractors, of patients, and of states which have legalized chiropractic. Never has a chiropractor requested a research grant from the National Research Council of Canada, nor from that of the United States. Even today, chiropractors offer no prospect of contributing to science, as witness their Bill 216.
Practically speaking, what can chiropractic offer a patient? A person appears who may be suffering from a variety of illnesses, some benign and tending towards spontaneous cure, others grave and even mortal. For all of these diseases, since 1895, chiropractic has offered a single treatment -- the manipulation of 24 vertebrae. It is the claim of chiropractic that health in human society can be protected simply by maintaining the alignment of these 24 vertebrae.
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