Talk:Chiropractic/Archive 1

This is the archive of Talk:Chiropractic/Draft up until Jan 1st, 2007.

lead

I re-wrote some of the lead to bring it into the 21st century. Chiropractic is much bigger and more complicated than just the looking for and treating the mythical subluxation;) We really treat a lot of pain and work with a lot of musculoskeletal problems while asserting that taking care of your spine is a good idea. That is not to say that there weren't all kinds of methods that have been tried and developed over the years, but they can pretty much be boiled down to working toward this end. --D. Matt Innis 20:56, 3 December 2006 (CST)

Thanks Matt. ..."potential nervous system interference"... think we need in the lead to explain things simply, can you have a think about a rewording that might work for say a 14 year old? Gareth Leng 09:07, 4 December 2006 (CST)

I spent all that money to learn how to think like a 14 year old:) There's a joke in there somewhere. You said it best, I just replaced it! --D. Matt Innis 10:33, 4 December 2006 (CST)

Chiropractic vertebral subluxation

I think you're right that the VS should be closer to the top. I also think that we can do a better job explaining it. Lets go for it. I'll try and get it all down and if you would go behind me and clean up that would be fine. --D. Matt Innis 15:15, 5 December 2006 (CST)

Hi Matt. There's one thing I'm very unclear about. DD Palmer clearly saw that promoting chiropractic as a religion might protect it from being taken over by the medical establishment. How much of this was sincere and how much was it just a stategem? In other words, did he deliberately stress the mystical associations of some concepts, in almost a cynical way? Or did he indeed become self deluded and see himself as a prophet?Gareth Leng 05:32, 6 December 2006 (CST)

Gareth, as you know, I have been reading everything I can find to determine this very question for the last 6 months. There are sources that state it both ways. The problem is that there were battles going back and forth from BJ's group vs DD's group and the mixers (John Howard, et al at National, etc.) on the side shaking their heads. Because BJ had taken over the "fountainhead" role, DD was dying to get it back. He tried to open several new schools, even calling one "Fountainhead", but he couldn't pry it loose. Meanwhile, BJ and his group were building a philosophy based profession and finding a way to get the practice of chiropractic legally seperable from medicine. When DD made the "religious" statement, California (the state has was wanting to move to from Oregon) was fighting a fierce battle with medicine to create a law that would protect chiropractors. BJ's straights kept interfering and because chiropractors could not reach a consensus, they were not able to do so. Meanwhile chiropractors were going to jail by the boatloads. Seeing that BJ was becoming the "philosopher" of chiropractic, and seeing how christian scientists had just won the right to practice citing freedom of religion, it does not seem far fetched to see that DD could kill two birds with one stone; become the "leader" of chiropractic again, and free the profession to practice without the threat of jail. From what I can tell, he was rejected, though that could be because he died months later. BJ then covered up his fathers writing until his death in 1963 in the Palmer archives.

So, I think a case can be built either way using resources, but if we put them all together, it looks to me that DD was intially making sound and bold scientific statements about his idea. He was reducing them as he found out new information, even from nerve pinch to no nerve pinch in the intervertebral foramen, etc. But, after going to jail, his attitude changed drastically and the "vital" elements from his past began to show back up. He was really wanting to be a scientist, but because of the political environment, it wasn't going to happen. I really think that the next several generations held these concepts in order to keep medicine from dictating how they could practice until science could catch up, similar to John Howards statement about "DD palcing a veil around chiropractic to protect it until it grew up." --D. Matt Innis 07:07, 6 December 2006 (CST)

On Approval - I think we need to set in place a process for approving this article, and I'd propose that we ask Nancy if she'd take on the role of "objective editorial oversight" to guide and be the ultimate arbitor.Gareth Leng 05:32, 6 December 2006 (CST)

Comments and suggested changes by Nancy

Chiropractic approach to healthcare

current article text : The traditional, 'medical' or 'allopathic' approach to health care regards disease as usually the result of some external influence, such as a toxin, parasite, allergen, or infectious agent: the solution is to counter that influence (e.g. using an antibiotic for a bacterial infection). By contrast, chiropractic involves a naturopathic approach, believing that lowered 'host resistance' is necessary for disease to occur, so the answer is to strengthen the host.[7]

My comment: Allopathy is a historical practice, and does not connotate current medicine. Medicine is simply medicine, the professional current practice of medicine, and not 'medicine ', If you hyperlink medicine to the current CZ article, that might help. I think a line like: "Although host responses and resistance are considered important in medicine, few treatments in mainstream medical practice are actually aimed at fighting disease through augmenting host response alone." In medicine and nursing, host resistance is more often generally approached through nutrition, exercise and physical therapy.

If I wait too long on an editing page, I'll have a problem posting and so my comments are going to be parcelled. more to come. (by the way, I think the writing is very good) Nancy Sculerati MD 07:09, 6 December 2006 (CST)

Allopathy is a historical practice, and does not connotate current medicine.

I am so glad to see you say that. I agree. I have that same problem with chiropractic. The current practice of chiropractic is the whole of what chiropractors do, not just the DD Palmer definition. But when we begin to write that, we realize that when we say chiropractors use physical therapy, we are stepping on the toes of physical therapists who claim it as theirs and nutritionists, etc. But pigeonholing both medicine to "drugs to fight disease" and chiropractic to "free the 'vital spark'" is really innaccurate. We have to differentiate chiropractic from what chiropractors do and medicine from what medical doctors really do. Perhaps we should say 'the allpathic model" or "the historical allopathic model". Or we can return to using this as the quote from Rbert Mootz,D.C as his opinion. What do you think? --D. Matt Innis 08:47, 6 December 2006 (CST)

What about treatment of systemic disease and local infections?

Personally, I would go to a good chiropracter in a minute for a musculo-skeletal problem, and have, in my practice, referred to selected chiropracter's for treatment of back pain. So, I want you to know that I am not an 'enemy physician'. But there is a big issue here that is unsaid. There are many chripracters (at least in NYC) who treat cancer, AIDS, allergy, ear infections in children and basically any illness through adjustments. Some of them tell their patients that antibiotics and other generally accepted medical treatments can interfere with the success of chiropracic therapy. There is nothing at all mentioned in this article about the treatment of specific illnesses, such as breast cancer or gallstones or otitis media in Chiropractic. That is too important to leave unsaid. Matt, could you address it? Do all chiropracters' treat all illnesses? What's the code of ethics for referral? Are there specific schools of chiropractic that have differing outlooks in this regard. I will re-read article, but I don't think this is discussed. Nancy Sculerati MD 07:24, 6 December 2006 (CST)

more specific comments

Here are more comments. I won't make any changes in your article unless explicitly invited for each change I suggest. I view my discussion of your paper as a CZ experiment in alternative editing. Maybe we can develop friendly professional protocols that change the culture without losing the great benefits of open interaction!

You have made a very nice article, that – as far as it goes, is both readable and generally accurate. It’s the best single article I have ever read on the subject. I do think it needs improvement – primarily because it must address the treatment of illnesses other than musculoskeletal pain and conditions by chiropractic to avoid being a misleading introduction of its subject. I cannot begin to address that issue myself. I don’t know the field and I don’t know where to learn about it. I think you (Gareth and Matt) are great resources and I am tremendously interested in reading what you come up with. Except for that, I think this article is ready for approval and should be temporarily frozen in anticipation of the launch. I do think there are minor improvements you might consider, but these, in my mind, (unlike the systemic disease issue) in no way preclude approval.

Since every good article has a voice, and having many writers writing the same piece without orchestration tends to muffle it, instead of accentuating it, I am limiting myself to the discussion page. If there is anything I write here that you’d like to use, take it and cut and paste as you wish. If not, that’s fine too.

1.(present version of article) “In conventional medicine, the term subluxation is usually associated with conditions which are a direct consequence of injury to joints or associated nerves. [1]”

I think that this is much too subtle to be informative. If the reader does not already know both the medical and chiropractic definition of “subluxation” (and few will, I didn’t) they won’t get it. Even if they read the hyperlink, they might not understand. That hyperlink text for subluxation is neither clear nor strictly accurate.

1. (suggested change) The same word, subluxation is routinely used by both physicians and chiropractors, but each of these professions means something entirely different by the term.

The chiropractor uses this term to refer to an invisible phenomenon that involves forces of mental energy that are not described in current biology and not recognized as real by the physician. (full description of just exactly what a chiropracter means by the term in plain language).

A physician, on the other hand, only refers to a body part as” having a subluxation” if it is indisputably out of its functional position. So, when a radiologist reads a spinal x-ray as “showing subluxation of a vertebra”, he or she always means a bone in the spinal column is visibly displaced on the image. A pediatrician calls the elbow joint of a child as subluxed in the condition “nursemaid’s elbow” only if the lower arm bones are pulled out of the joint capsule and the child cannot move the forearm.

The differing use of this term by physicians and chiropractors is one factor that has contributed to the hostility of much of organized medicine against the profession of chiropracter. A patient may feel benefit from a chiropracter's treatment of his back pain, but when he next sees his physician, and announces that the chiropracter "fixed my subluxation", that physician is prone to view the chiropracter as a fraud, rather than a healing arts practitioner who may be on to something useful. After all, she'd reviewed the cat scan of the patients back and knows for a fact that there was no subluxation!

Perhaps the lack of scientific recognition of the chiropracter’s meaning of subluxation is due to lack of a focused study by biologists. Arguments have been made that the theoretical basis of the maneuvers in chiropractic do deserve scientific investigation. However, with few exceptions, chiropractors themselves are not trained in science or in the use of formal research methods. (might fit some of that into the research stuff you already have) Also, I argue that the medical definition is actually a biological definition. It is not just true in medicine, but also would be used by a vetinarian, and by an animal physiologist – by anyone who uses the language of biology.

Anyway, regards to all and I'll stop back again soon. Matt, just write how it really is - but you have to reference it to the national or world state of the profession. It seems that the problem may be that most of the global literature was produced decades ago. Still, the article -though of course should go through the history, best serves the reader by describing the current profession. Best you can, honest and plain language (though also diplomatic, accurate and respectful- of course!!) :) Nancy Sculerati MD 09:24, 6 December 2006 (CST)

Thanks, Nancy, for your very insightful input. I think you have addressed the things that I needed to hear. Sometimes you can't tell if anyone else thinks they are important. I will also have to address them in pieces between other activites. Let me start with giving some input to your conversation to let you know where I'll be trying to go.

Consider for the moment that vertebral subluxation does not involve a "spiritual" component. Consider that there is a functional possibility that a vertebra can be in perfect alignment, but due to adhesions from an old injury, it does not move in the kinetic chain properly, it would not show up on an xray, or for that matter, may not show up if you moved the patient through gross ranges of motion. But if you were able to isolate that one joint and put specific pressures on it and it didn't move or have that "elastic feel" like those above and below it, you would certainly note that it was dysfunctional. We call it subluxated for lack of a better word (from way before our time). We certainly don't expect just anybody to find this, anymore than we expect just anyone to be able to palpate a tumor on the kidney; its a feel that you develop with practice, practice, practice. How many people can palpate an ovarian cyst?

Now, whether there are consequences of this "lack of motion" is also debatable. There is research that shows that if we pin two vertebrae together on a rat, signs of degenerative disc and joint disease begin within months. Is this important? Certainly from an arthritic and pain POV this is reasonably important. Some chiropractors assert that this is important for overall health as well. Certainly from the patient's POV it feels better not to have either of these conditions. There is also some research that may provide a link to th line of thinking about health in general; mostly along the lines of innervation by the recurrent nerve of the spine which exits the intervertebral foreman, innervating the facet and posterior disc before returning to synapse in the lamina levels of spine that coorespond with the gray matter for the autonomic ns. Whether this can explain effects that chiropractors claim by affecting perhaps the vasomotor tone of the blood supply to an organ system or whether the nerve carries some other mechanism of information (neurotransmitters or other end products) that determines the health of the organ is still up for grabs, but I think neuroscientists are getting close to finding that out. OR, are somatic referral systems from "subluxated" facets the explanation for a percentage of right shoulder blade and abdominal pain that is often misdiagnosed as gall bladder pain, accounting for the claims? Again, I think we are close to finding that out. --D. Matt Innis 12:29, 6 December 2006 (CST)

Many efficacious practices in medicine came about before the physiology was understood, often there was a rationale offered that was later changed. But you see Matt, a person such as myself, and practically anybody who is not a chiropracter only knows what's in the books, and that's the hundred plus year old theories. It would be like reading a medical textbook from the civil war and relating it to what goes on today in a hospital. So what I want to know from you is what a chiropracter actually does. I can tell you that all doctors, generally speaking, who see patients go through a ritualistic history, physical exam, review of labs and past history, and depending on specialty might offer treatments. Is there a protocol accepted as proper practice for chiropracters? Do you keep records? What do they look like? Do you take x-rays or perform tests? How is a chiropracter licensed? Certified? Could you write about that here in the discussion? Then, if you like, we could put it together in the article.Nancy Sculerati MD 15:09, 6 December 2006 (CST)

Nancy, I changed the conventional medicine subluxation line to this:

• In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment.

Not sure I've captured the essence, what do you think.

As an extra note, I think most chiropractors see this "imaginary force" as a mental process that has its foundations in an the physical/chemical world, but no-one has been able to reduce it to that yet. Certainly, an emergent process that is explained in concepts that get too complex for the average clinician to relay to his patient is a possibility. So basically, I think it boils down to the subluxation being a milder level of what medicine considers a subluxation with a couple added twists concerning the nervous system's role. Am I making sense? --D. Matt Innis 15:17, 6 December 2006 (CST)

I see you've written more, let me see some patients and I'll get back to you. The answer to all of it is; yes. --D. Matt Innis 15:17, 6 December 2006 (CST)

Chiropractic education etc.

Nancy, this is information that was in the WP chiropractic article at one time but has been split into other articles because the original got much too long. We have apparently imported them into CZ so it may be just a matter of adding the wikilinks, though we might want to paraphrase some in this article to give a short synopsis of each. Just give them a quick look and let me know what you think is the most important.

• Chiropractic education
• Chiropractic school
• Council on Chiropractic Education
• Foundation for chiropractic education and research hmm, this one is missing
• Federation of Chiropractic Licensing Boards
• National Board of Chiropractic Examiners

I think this is all related enough that we can probably write a short section and link all these from there. --D. Matt Innis 22:35, 6 December 2006 (CST)

I've had a go at starting to incorporate Nancy's suggestions, amplified in the light of your comments Matt - see if I've got it about right?Gareth Leng 04:58, 7 December 2006 (CST)

Matt, there is almost nothing in WP that is clearly written and plainly explains. So look through and rewrite or just write it yourself. I'd say. The goal (to me) is not to make a lot of high sounding rhetoric but to actually explain, like you would to a friend who is intelligent but knows nothing about what it takes to be a chiropracter, just how you get to be one, how people generally do, and what the professional and legal regulations are like. Explain it to me, I'd like to know and I am a friend, or at least a penpal. I'm asking you. Don't ask me to read WP for your answer. I don't want to. Nancy Sculerati MD 06:02, 7 December 2006 (CST)

Okay, have done some in VS and Education (tough to make education interesting). Feel free to comment and adjust (pun intended:) --D. Matt Innis 11:11, 7 December 2006 (CST)

Going through again and making comments-Nancy

1 current Chiropractors emphasize their belief that a patient's health is compromised when spinal injuries, which some call vertebral subluxations, interfere with the body's ability to maintain adequate posture and joint function. They assert that, when neglected, these conditions can lead to accelerated degenerative changes such as arthritis and, by interfering with the nervous system, result in many different conditions of poor health. In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment. [1]

Why not say- “Chiropractors believe that…” instead of “Chiropractors emphasize their belief that…” 2. Do you really believe that the problem is spinal injuries? From what I understand from what you have written, chiropractors do a maneuver to ‘crack’ or ‘pop’ the inter-vertebral joints. Even if this has benefits, it does not follow that the joints or spines were originally injured or in any way displaced. When you say “In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment.” It implies that there is a continuum between normal joints and subluxed joints, but that is not really true. It is not a continuous change, in medicine a joint is either dislocated or it’s not, it’s a quantum change. Subluxation specifically means that the joint is dislocated out of the normal position such that it is visible on x-ray and would be visible to the naked eye if you removed the soft tissues covering the joint. Are you arguing that everybody who comes to you has minor subluxations in that sense? If they are so subtle that they cannot be either seen by surgeons or radiologists than they don’t exist. Scientists reject the idea that something exists that cannot be measured. For example, you previously – in the talk section, not in the article, pointed out that many doctors cannot palpate an ovarian cyst that perhaps some doctors do feel. So yes, an ovarian cyst may be there and yet a doctor cannot detect it on physical examination. But even if an ovarian cyst cannot be palpated, if it is there it will show up on ultrasound, or CT scan, or certainly if the ovary was surgically removed and examined by a pathologist. If the ovarian cyst that is said to be there by a doctor cannot be seen on ultrasound, cannot be seen by the surgeon removing the ovary, and cannot by the pathologist sectioning the organ and examining it through a microscope, then it is not there. Nancy Sculerati MD 13:26, 7 December 2006 (CST)

Hi - Matt - we had an edit conflict, so I'll back off a while. The bits below were my edits, keep anything worthwhile

I'm done for awhile! Go ahead and do your thing to clean it up and tie it all together and we'll see what we have. I know I scatter my thoughts all over, that's how I think;) --D. Matt Innis 14:35, 7 December 2006 (CST)

There is ongoing debate within the profession as to whether there might be benefit in changing the terminology of subluxation to satisfy the medical model. Similar to when dentistry abandoned the term 'cavity' for 'carie' to describe a barely visible defect that preceded an actual pitting of the tooth that took the form of a cavity. The alternative term segmental dysfunction is already used for insurance and statistical purposes, so making the transition would be relativley easy, but this terminology does not entail the nerological component of the condition.

Perhaps the lack of scientific recognition of the chiropractor’s meaning of subluxation is because biologists have not given the concept much serious attention. Arguments have been made that the theoretical basis of the maneuvers in chiropractic deserve more scientific investigation, claiming that, with few exceptions, chiropractors are not trained in science or in formal research methods. But chiropractors argue that their concept allows them to see their patients as more than the 'sum of their parts'. They believe that trying to explain all the complex physiological processes that combine to make a human being function in terms of the basic underlying physical and chemical components, misses things that are important for understanding what makes a human being healthy. Perhaps this is why chiropractors have been so reluctant to join their medical counterparts in their pursuit of the scientific answers to disease. They tend to prefer to interest their patients in taking part themselves in building health and wellness. Some contend that retaining the holistic concept of subluxation is an important element in preserving that principle. Gareth Leng 13:29, 7 December 2006 (CST)

Hi Nancy, I think you're getting to the heart of the divergence of views in your comments. But I'd wonder whether it's really true that 'Scientists reject the idea that something exists that cannot be measured', after all we commonly admit that 'lack of evidence' is not 'evidence of lack'. I think it is true (and rightly true) that scientists are very reluctant to invoke any redundant explanations or introduce unneccessary concepts, but we are often forced to where we encounter things we can't explain; often they are 'holding terms' until an explanation becomes clear, but sometimes they last a long time. I'm thinking especially of mental states - like stress or anger or anxiety, we have a pretty poor understanding of what these are, and essentially they are still high level concepts awaiting mechanistic explanation. Most relevantly, wjhile we know that the mind has an influence on how we recover from illness, we have a very limited grasp of what this involvesGareth Leng 13:39, 7 December 2006 (CST)

I need to clarify my meaning - and, as always, I could just be wrong. But I say that if something by definition cannot be measured or detected in anyway, then it has to be said to have no real existance. Meaning, maybe a sound does not show up on a picture, maybe it is not 'heard' if no one is there to hear it, but there is, at least in theory, a way to measure a sound. And if you claim that there are sounds, but that these are simply are too subtle to be detected by any method, inccluding the most sensitive instrument to detect molecular motion, then I say there are no sounds. Maybe there is something there, but it's not a sound. I had prepared some comments before I came back to the talk page and read your last entry. Take a look below at the ovary business. I'm pasting the comments in just after the period here.

Let's go back to the ovarian cyst. Again, if an ovarian cyst cannot be palpated, if it is there it will show up on ultrasound, or CT scan, or certainly if the ovary was surgically removed and examined by a pathologist. If the ovarian cyst that is said to be there by a doctor cannot be seen on ultrasound, cannot be seen by the surgeon removing the ovary, and cannot be detected by the pathologist sectioning the organ and examining it through a microscope, then it is not there. Either the doctor who palpated it and identified it made a mistake, or there was something there and it went away before the subsequent tests were made, or there was something there (that's probably still there) that was not actually in the ovary. If a doctor says, well - the cyst is there, and it is absolutely in the ovary, but any attempt to detect it will fail - yet not remove it in a curative sense and I'm reluctant to any way try to actually detect it - but I insist that it is a cyst on the ovary- what are we left with?

Unless I've got it wrong ( and I may) a chiropractor is insisting that there is a joint dislocation that is so small that even the most sensitive scan cannot detect it, yet it is a true physical dislocation of the joint. I say, that cannot be so. Perhaps there is a problem with the joint, but it is not a physical dislocation. Perhaps it's something in the way the joint moves, and if that's so there is a way to measure it. Measurements do not have to be invasive. Maybe it is nothing to do with the joint in terms of a problem, but manipulating the joint still provides a health benefit. In other words, perhaps there is a difference in blood flow or neuronal activity or something after the manipulation. The fact that it hasn't been measured does not mean it can never be measured. But if for political correctness within chiropracty we have to insist that there is simply an unmeasurable physical dislocation of the bones in a joint capsule, one that is by definition too subtle to be measured in any way - I say that's religion, not science. And, by the way, I believe that religion works as a cure for some ills in some cases.Nancy Sculerati MD 15:12, 7 December 2006 (CST)

You've got it exactly right! What we're saying is that there is something physical there and we feel it with our fingers and it is slight. We feel it the same way a gynecologist feels the ovarian cyst. I wouldn't expect a gynecologist to feel a subluxation any more than I can feel an ovarian cyst. It takes practice and you have to know what a lot of normals feel like before you can find an abnormal. This part is not the religion. The religion comes when someone believes that when they "pop" the joint, it frees Innate Intelligence to flow to the body. But that is another story. The scientific chiropractor is looking for the neurological or blood supply changes that you suggest. Am I making sense? --D. Matt Innis 16:05, 7 December 2006 (CST)

And, along those lines, I also believe there are real effects of religion and prayer, and plan to use them when the time comes, but not in place of medicine or surgery;)--D. Matt Innis 16:26, 7 December 2006 (CST)

well, not really for the article - but in terms of general discussion, there are reasonable ways to go about testing for objective evidence. For example, if a patient has an ovarian cyst - more than one experienced doctor can feel it. I don't say everu docyor, but among GYN oncologists, who are probably the best at feeling pelvic masses on exam, it won't be that only 1/500 experienced ones feel it. So, one way to approach research in this field might be to select a number of chirppractors who are experienced and well trained. Take 20 patients. On a single day - have all the chiropractors, one by one but not in the presence of each other, feel that patient and list just where adjustments are needed, but do no adjusting. Ideally, when testing examination capabilities there is some gold standard, like surgical examination of the ovary or at least an imaging study, but I accept that here there may not be. On the other hand, if we could be free to imagine any research protocol - I'd say take patients who were already scheduled to get CT scans of their backs. Let the group of chiropractors examine them. Then compare the CT scans, and the chiropractors findings. It should be that several (not all but more than a chance number) of chiropractors agree on certain joints as needing adjustment. If so , then having a radiologist examine the scans and look at those joints as compared to those that no chiropractor thought needed adjustment might reveal some ojective radiological findings (not necesarily dislocation - just something) that correlates. I'll do a search to see if anything lik that has ben done.Nancy Sculerati MD 17:09, 7 December 2006 (CST)

Yes, vertebral subluxation is much less than a dislocation. It may also be aligned correctly but not be moving correctly. This is why we differntiate as "a misaligned or dysfunctional" vertbra. The technology is here and it is starting to show us. MRIs were showing atrophy of the multifidus muscle at the level of the patients pain seen on MRI years ago, but nobody was looking. As you know, these are the small muscles that run only from one lamina of a vertebra to the spinous process of the next vertebra. In other words, these are deepest and most intricate muscles related to the facet joint that gets palpated. If a joint get stuck, it is the one that will atrophy first. They get their nerve supply only from the nerve that exits at that level. When palpating, you attempt to feel the relative symmetry of the muscle bellies of this and the erector spinae. When you find one that is tight or you feel only a hard boney feel that doesn't move properly (sometimes they move too much), you know it is an area that is having trouble, whether it is from an old injury, a new injury, or postural abnormality. The patient knows you found it as well because it will be tender. We would certainly identify that as a subluxation. Depending on the history and what we are considering doing about it, we might xray to see if there were signs of degenerative joint disease so that we could get a feel for how long it has been there. If the xray looks normal that does not mean that no subluxation exists, only that it is pretty safe to assume that it is relatively recent(within the last couple years). There are too many factors for deciding that and it becomes more of an art than a science, but you do similar things in your practice I'm sure. The xray may also helpbmake sure that there are no contraindications to manipulation, i.e. spondylolysis, osteoporosis, osteopenia, unusual anomalies, metastatic cancer(one-eyed pedicles or osteolytic and osteoblastic activity), aneuysmal bone cysts, etc.. There is so much more to it than that, but I hope it helps you understand what and why we do things the way we do. It is no longer a question of "do these exist" it is "are they significant" and if so, significant for what? Do they have any effect on health whatsoever? Most of us really don't expect anyone to find a "spiritlike" creature, but we would like to know whether the nervous system can play the role that DD Palmer originally postulated - adjust vertebra = affect nerve = affect health.

This is just one example of how the information is coming out [1]. No we don't have all the answers, yet, but that it doesn't mean that we are going about it in an unscientific way. There is no-one more anxious to find out these answers than we chiropractors, we just need the resources to conduct the research and it is coming slowly, but surely. --D. Matt Innis 18:53, 7 December 2006 (CST)

So, Matt & Gareth – some specific article comments.

1.If your only evidence that some chiropractors are trained in surgery is that an individual chiropractor claimed he was, then I think – for now- you should take that out. That’s the sort of thing that needs to be firmly proved before stating it in the article, and by documented sources like actual copies of state laws, not by here say.

Done --D. Matt Innis 21:16, 7 December 2006 (CST)

2. In conventional medicine, the term subluxation is not be used until these joints show a more obvious pattern of pain and misalignment. This is not true. There can be a subluxation without pain, a subluxation does not even have to be in a joint – for example, the lens of the eye can be subluxed. Subluxation means( in conventional medicine), that there is a physical dislocation such that the part is completely out of place. Period.

Nancy, would you put that in for me so we get it right this time. --D. Matt Innis 21:16, 7 December 2006 (CST)

3. I was really struck by your descriptions of what you do, and I think you should incorporate them into the article. You wrote” When palpating, you attempt to feel the relative symmetry of the muscle bellies of this and the erector spinae. When you find one that is tight or you feel only a hard boney feel that doesn't move properly (sometimes they move too much), you know it is an area that is having trouble, whether it is from an old injury, a new injury, or postural abnormality. The patient knows you found it as well because it will be tender.” Perhaps you might (for the article) write: The chiropractor palpates the spine to carefully feel for the contour of deep muscles that run from vertebra to vertebra. The relative symmetry and flexibility of the multifidus and erector spinae muscles are clinically assessed during that examination, along with their associated structures. When an area of musculature is feels tight, hard or boney, the chiropractor checks to see if the vertebral joint under it often moves properly. If the joint is either stiff or unusually mobile, such an area is identified as a trouble spot, which may be secondary from an old injury, a new injury, or postural abnormality. Often, the patient also identifies that same spot during the chiropractor’s examination because of pain during palpation. Unless I got the above wrong, of course. Nancy Sculerati MD 21:03, 7 December 2006 (CST)

You got it right! I'll put it in an you are welcome to clean it up. I do get wordy sometimes and I need somebody to keep me on topic:) --D. Matt Innis 21:16, 7 December 2006 (CST)

Did you see the answer to your cavitation question? --D. Matt Innis 21:16, 7 December 2006 (CST)

---

I went to the hyperlink on cavitation and I couldn’t easily understand it. Please fix it. Which kind of cavitation do adjustments depend on, inertial or non-inertial?

Inertial, I describe it to my patients like when you open a pepsi bottle and you release pressure and bubbles form (only in the joint you are creating a relative vacuum). They will stay there until they are resorbed by the fluid again - or in the pepsi example, when it goes flat. During that time, the joint space is widened and results in more motion for the joint. From what we can tell, the reason they feel better is because there is a blast from the mechanoreceptors in the facet capsule that overwhelm the normal proprioceptive feedback loops (gate theory) and decrease pain similar to scratching an itch. NOW - is there a reflex arc that has effects the organs innervated at that level of the spinal cord? This is what chiropractors "believe" and "emphasize" as the reason for their treatment, because we don't "know" that it is there, "yet".--D. Matt Innis 16:47, 7 December 2006 (CST)

The article says "Some also use other complementary and alternative methods. However, chiropractors do not prescribe drugs; they believe that this is the province of conventional medicine, while their role is to pursue drug-free alternative treatments, but some are trained in minor surgery."

Exactly what surgery procedures do chiropractors do? Exactly what is the training? Which are trained? Nancy Sculerati MD 14:55, 7 December 2006 (CST)

A chiropractor stopped by from Portland Oregon who said his school taught minor surgery and it was legal in Oregon and other countries. I would assume they mean things like taking off warts or something along that line, but I really have no idea. I will check into it. --D. Matt Innis 16:22, 7 December 2006 (CST)

Opening too long?

I wonder if the opening paragraphs could be trimmed? Shouldn't it be more like an abstract (~300 words) of the article? The first section could be an overview type section if you think this is still required. Chris Day (Talk) 16:49, 7 December 2006 (CST)

I think Gareth and Nancy would probably be best for this... everything I do adds more words and before we know it we'll have to split the article again! --D. Matt Innis 21:37, 7 December 2006 (CST)

Much better! This is really coming together nicely. You guys are goood! Are we missing anything? --D. Matt Innis 10:54, 9 December 2006 (CST)

Cavitation gif

I added an animated gif for cavitation. Is it helpful or does it take away from the quality of the article? --D. Matt Innis 10:52, 9 December 2006 (CST)

I liked it.

Should I make it so it "cracks" constantly or just when you click on the "see animation". --D. Matt Innis 22:55, 11 December 2006 (CST)

btw, Tom Moore or Tom Morris???

Morris! Tom Moore was a fellow scoutmaster:) --D. Matt Innis 11:23, 10 December 2006 (CST)

Need a para to meet Nancy's major concern (treating other conditions). This will need you and I Matt. I could have a go but won't get it right first off - shall I try and you can put me right?Gareth Leng 10:36, 10 December 2006 (CST).

Yes, maybe it would be better for you to start with what you think is important and I'll clarify. That way I won't go overboard on tangents. For references, dysafferentation gives a great history of research that makes an effort to explain the science behind the concept of subluxation, Sympathetic nervous system response to mechanical stress of the spinal column in rats. shows that there may well be some autonomic response that affects organ systems, and Somatic dysfunction and the phenomenon of visceral disease simulation: a probable explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from true visceral disease discusses that maybe there is confusion about the etiology of pain - perhaps the reason the patient failed with medical care was misdiagnosis it was somatovisceral in the first place. But I am sure you have a pretty good feel for what is needed for the article on your own.

I can't wait to read it! --D. Matt Innis 12:02, 10 December 2006 (CST)

Non-spinal disorders

OK, first shot - up for brickbats.Gareth Leng 05:13, 13 December 2006 (CST)

Hey, you've been holding out on me;) Now we're talking! Very well put and succinct. You have a very good grasp. Okay, I'll do my thing in short spurts throughout the day. You are welcome to cleanup at any time. I do see some things that I think we can square. --D. Matt Innis 07:55, 13 December 2006 (CST)

OK, took a few shots myself. Yours are pretty solid. I think we have a way to go. Nancy, if your watching, feel free to jump in because I can use your POV otherwise I am just making assumptions. --D. Matt Innis 21:15, 13 December 2006 (CST)

Also, I think we're going to have to trim the history some and create another article for chiropractic history. I don't want to lose the total story because I think it answers a lot of questions that everybody (including chiropractors) ask. What do you guys think? --D. Matt Innis 21:36, 13 December 2006 (CST)

I've removed this sentence as I didn't understand it "BJ Palmer reduced the adjustment to 'Hole In One' - the adjustment of only the atlas, while mixers continued to add and refine techniques to find and reduce subluxations." Maybe this should go in the BJP article?

No big loss, nobody uses that terminology anymore. Apparently it is now Specific Chiropractic (specific to the atlas vertebra). --D. Matt Innis 07:38, 14 December 2006 (CST)

You know I love the history and I really don't want to see it go elsewhere, although it deserves expansion elsewhere. Lets try and tighten a bit and see what Nancy thinks.Gareth Leng 04:27, 14 December 2006 (CST)

OK, sounds good. --D. Matt Innis 07:38, 14 December 2006 (CST)

I've made the article on DD Palmer live and taken the religion quote into it in full; I thought maybe it was tangential here. Think we need to look at the effects of the reordering - I see that the Flexnor report is now mentioned before its described etc., a few things like that.Gareth Leng 05:53, 14 December 2006 (CST)

Yep, it's reshuffle time then we can go another round. --D. Matt Innis 07:38, 14 December 2006 (CST)

Good job guys. I'm liking it more everyday. Nancy, nice touch on the lead.. keep working! --D. Matt Innis 13:51, 14 December 2006 (CST)

Will do. hey, what are brickbats and how come you both understand that word? Nancy Sculerati MD 14:33, 14 December 2006 (CST)

LOL! I didn't say I knew what brickbats were, only that I knew what Gareth meant:) I'll take a jab at it - I picture large flat bats that are used to break ?bricks? or maybe to paddle bad kids! --D. Matt Innis 14:44, 14 December 2006 (CST)

Oh, wait a minute - maybe it has something to do with the all british past-time, Cricket! --D. Matt Innis 14:46, 14 December 2006 (CST)

Heck no! I was WAY OFF! [2]

Lets get the cancer thing right

It is important that we get this right, at least on a rationale basis:

• There are chiropractors who are willing to use adjustments to treat any disease, including AIDS and cancer, in both children and adults.

I shutter to think that there might be someone out there telling their patient that they are treating their cancer or AIDS as a chiropractor. Having said that, I think it is safe to say that all DCs treat patients that have AIDS and some cancers (provided their are no red flags - metastasis to the spine, osteopenia, etc.). I generally tell them that if they think it is helping them in any way, use me as you see fit, but be sure to let their MD know. Those few patients that I have seen are also going through the medical route with chemo, etc. Though I suppose there are those that may choose not to do the chemo and go to the chiropractor instead, hopefully the chiropractor is telling them that it is not a cure for cancer or AIDS! If not, they are certainly at risk of violating most chiropractic legislation that states that a chiropractor may treat what they are taught in school. At Logan, in our jurisprudence class, if we answered any question wrong concerning what we should do with a cancer patient, we immediately flunked the class - NO QUESTIONS ASKED - no passing GO, no second chances. Nobody ever missed those questions. In other words, I don't think this is common acceptible practice in chiropractic. I would really like to know if this was really something you guys hear from reliable sources or is this one of those rumors that goes around? Or is it that the chiropractor is using homeopathy or some other CAM. If that's the case, then how do we handle that? I'll stop now. --D. Matt Innis 16:19, 14 December 2006 (CST)

Matt, I had edited that out even before I read your post. I edited it out when I got to the Mercy guidelines. But then, I came to the talk page to ask you the question I am about to pose, and I came across the above post. Anyway, please know that I lived in Greenwhich Village for about 30 years and I practiced medicine in NYC for about 20 (counting residency). There are people who go to DC for adjustments for treatment of their immune system and cancer, but I'm not claiming on the basis of what I know that this is because the DC misleads them or is specifically treating them for those illnesses. Frankly, in my earlier days AIDS was considered not only incurable but untreatable ( in the early 80's) and so if a DC was offering treatment I wouldn't even consider that unethical. I do know that Otitis media and allergy were specifically treated in the 90's by DC in Manhattan, and that they wrote about it in local neighborhood papers and circulated sort of "info-mercial" papers. Since the original DC did treat everything, I made an asumption and am glad to have you correct it.

But what I want to see are the written guidelines of what to treat and not treat. I can't find them in that Mercy book. It may just be that I'm not looking in the right place. Can you show them to me? [If not there, somewhere else? [User:Nancy Sculerati MD|Nancy Sculerati MD]] 16:43, 14 December 2006 (CST)

What about the length?

I do not want to butcher this article, but we have a real problem with the length. This is what I propose: for now- we have previous versions and can always put it back- lets take out all the "Three Rivals" stuff and put it in a new "History of Medicine" or History of Medicne in the US and link it. I'm going to try. Nancy Sculerati MD

I just looked again, and that's not a good solution. I also looked at the biology article, it's 37 kbytes. I really think we have to aim for under 40. Can we do a History of Chiropractic article and link it? We should keep the first stuff on palmer in there. Matt and Gareth- would you each comment, please? Nancy Sculerati MD 17:21, 14 December 2006 (CST)

We had this same problem on WP and had to cut out a lot of history, all of education and regulation, and most of the heart of the article. It pretty much gutted it. That's why when you asked about adding stuff, I hesitated, but I am okay with it as long as it gets replaced with something better. So far all the changes have been for the better. I'm open to any ideas and know that we can always put things back as long as we end up with an article that accurately, neutrally and sympathetically paints the proper picture. --D. Matt Innis 19:49, 14 December 2006 (CST)

I went ahead and made a new Chiropractic History article and copied it over. We can always delete it if we don't want to use it, but if you guys want to try some things go ahead.

As a note, I do think that having the history helpd to explain why chiropractic and chiropractors say the things they do and act the way they do. It also helps to realize why the research is not where it would have been had things not happened the way they did. It's something that I think neither chiropractors nor MDs knew at the time. They both just believed what was spoon fed them. --D. Matt Innis 20:44, 14 December 2006 (CST)

I'll go look at the article now. I think we have to be able to say just what you said above, Matt, in the text. Nancy Sculerati MD

How about we ditch the Critical section, too. This was a compromise section from WP that can be integrated elsewhere as well. --D. Matt Innis 07:27, 15 December 2006 (CST)

The lead seems to repeat itself. We can probably combine some of it further. --D. Matt Innis 07:52, 15 December 2006 (CST)

I also think that there is too much information about chiropractic to be squeezed into one article. Vertebral subluxation can take up 32Kb all by itself. We'll need articles on VS, spinal manipulation, spinal adjustment, history, science, use of CAMs, and perhaps the controversial issues. So maybe we should consider this the flagship article for chiropractic and link from here. Each section could just be a succinct and interesting narrative tidbit that you guys do so well about each subject and split off into the main article from there. Any comments? --D. Matt Innis 07:59, 15 December 2006 (CST)

Down to 46kB, and I think it's surviving well??? Gareth Leng 08:23, 15 December 2006 (CST)

OK Critical section is delegated, down to 41kBGareth Leng 08:38, 15 December 2006 (CST)

I'm still holding my breath;), but trust you guys implicitly. --D. Matt Innis 08:41, 15 December 2006 (CST)

This sentence:

• Although there has never been any scientific evidence that adjustments help such conditions, there is a growing body of medical literature that proves chiropractic care is as effective as physical therapy and conventional non-surgical medical treatment of back pain, even for the more severe underlying conditions that most often prompt patients to undergo spinal surgery.

There is evidence that professes to be scientific, and even has some peer review, though there is question as to the quality of the methods used and the peer review process. I am not the best to put this into words that can satisfy both POVs and still remain accurate. I would appreciate any input. --D. Matt Innis 10:18, 15 December 2006 (CST)

OK 40kB and I think my knife is now blunt. I've created a new article for critical views. Matt, please look carefully and see where I've cut too deep or if I've changed meaning or balance. I'll look at any specific points later, please don't be shy of saying that anything doesn't look right. I know the history is now simplified, but hope the thread is still OK, and the main article on history will give the embellished story.Gareth Leng 10:45, 15 December 2006 (CST)

Matt, I've been playing with words here and there. I am concerned about the caption for the radiograph. Since readers often look at pictures and read the caption even though they have not read the full text, I do not like the word subluxation under the radiograph of the spine, when any one who can read a radiograph of the spine will immediately object "there is no subluxation!!". So, for that specific caption, could you kindly change the word subluxation to segmental dysfunction or something that will fly without discord? Nancy Sculerati MD

Nancy, since this is the chiropractic page, I think we should probably stick to chiropractic jargon. Though I think chiropractic and medicine are slowly approaching each other in terms of understanding and practice, I'm not sure that we are at the point where we can describe chiropractic in only medical terms, mostly because of the vitalistic approach and lack of a better word for the "theoretical sub-optimal subluxation". As Churchland observed "If a restriction in favor of operational definitions were to be followed ... most of theoretical physics would have to be dismissed as meaningless pseudoscience!" Chiropractic has its own language, just like physics. If we don't use chiropractic language, we won't be able to get other chiropractic editors to back this up? We have to describe things in chiropractic terms, then we can point out similarities and differences if we want. Remember, chiropractors were some of the first to use xrays to evaluate the spine, and this is where the word subluxation degeneration was coined. How can we take that away from them? Make sense?--D. Matt Innis 18:25, 15 December 2006 (CST)

Where do we go from here

I worked mostly with the lead tonight and a little elsewhere. It's looking pretty empty to me. I'll look at it again tomorrow. --D. Matt Innis 22:39, 15 December 2006 (CST)

I think it's accurate, balanced and interesting, and I think I've checked every cited source myself. Personally I liked it better longer, but can see this is very much a subjective assessment and that a more concise article will meet the needs of this better. We can quibble about occasional words, but I honestly think we'd be worrying about things that won't even be noticed by most readers and won't be dwelt on by the few that do, so I'd be more concerned just to get the prose flowing sweetly in the last edit. I think the important question is for Matt - does he (and will his fellow chiropractors) feel that this article is a good and fair account of their profession? You say when you think it's ready to approve.Gareth Leng 05:14, 16 December 2006 (CST)

I agree with you Gareth, but I know that I do because Matt wants to have an article that is fair and neutral. Since we have already explained the word subluxation as used by chiropractors and said that this is our default meaning of the word, it's fine to use it for the caption. I still have one problem in content, Matt. Since extreme Straights are likely to have a position different from yours about treating serious systemic diseases that have a recognized convention medical cure, I just want some official DC source to quote that says this is not ethical (or proper or something). You told me that (more or less) any student in one of the programs would fail if he or she said otherwise, that say manual therapy was the treatment of choice for early breast cancer, but Matt, you only went to one school! There has to be something you can find, and it's best if it come from your own profession. Like I said, I can't find it in the Mercy Guidelines. Is it there? If we can't find it- then I'd like to put a sentence in the article to that effect that we write ourselves. Nancy Sculerati MD 06:17, 16 December 2006 (CST)

Nancy, I see what you mean. I'll look for something. If we find something, it will probably say along the lines that require referral to the appropriate specialist. I'm not absolutely sure, but in Michigan, their law was one of the "model law" straight laws that prohibited a chiropractor from diagnosing anything, therefore recently when a chiropractor was sued for "failure to refer" a breast cancer patient, he was aquitted. I'll see what came of that, too. --D. Matt Innis 07:57, 16 December 2006 (CST)

Found this, this, this, and this. Notice that is talking about using chiropractic for pain in cancer patients, not the cancer itself. This is what your looking for!. I went ahead and looked them up and found this same guy- you goota read this! [3]. Looks like he went overboard:) Though I think it illustrates what I was saying that anyone that says that stuff is risking his license and if someone dies, jail time. At least if he is calling it chiropractic, because chiropractic doesn't cure anything. --D. Matt Innis 08:05, 16 December 2006 (CST)

Otitis media in infants?

Matt, you are adding a lot of speculative things about how DC might turn out to be helpful that I can't live with. That otitis media stuff in infants is one. Colic is another. Generally claiming that "calming a mother" by manipulating the cervical spine of a newborn or infant for a "placebo effect" when for example - most otitis media in infants NEEDS NO TREATMENT and the rare infant that has meningitis almost always ALSO HAS OTITIS MEDIA, and meningitis in its early stages is hard to recognize, and might even begin with the high pitched cry that most people would assume is just colic, especially if the baby has a history of colic - is not something that I can ever approve. This is just the sort of treatment of nonmuskuloskeletal stuff I'm talking about that I consider unethical! We have a problem, Nancy Sculerati MD 10:08, 16 December 2006 (CST)

OK, let's keep cool here. I'm not sure that there is anything much wrong with the text here, except in one small place where there seems to be an inadvertent promotional statement. I think the situation is this, please correct me - patients visit an MD or a DC for otitis media or colic. OK. For an MD this usually needs no treatment. For a DC, maybe some would treat, and the treatment reasures the mother and thereby calms the infant. The DC sees nothing wrong in this, even if the effect is just placebo. Nancy is concerned about DCs missing more serious causes - right? Important, as they're often missed by MDs too.

In the UK at least, MDs do have a problem, in that they know that the placebo effect is powerful, but can't ethically use it (they have to explain the basis of the treatment to their patients). They know also that time spent with patients results in higher cure rates, but don't have the time.

Of course you are right, but keep in mind that it assumes that the doctor sees it as a placebo effect. DCs have an explanation for the effects. It is new research that says the effects of chiropractic on ear infections is about the same as placebo. I'm sure that will eventually play into the overall picture, just as it has for diabetes, cancer, etc. It won't mean that these people can't benefit from care, just that the patients with ear infections are not affected any more than a placebo. --D. Matt Innis 23:30, 16 December 2006 (CST)

So here seems to be the core of the dilemna. Can you encapsulate your concerns about the ethics of DCs treating infantile colic Nancy? Is it (just) concern about diverting from appropriate treatment in rare cases of serious illness? Gareth Leng 10:57, 16 December 2006 (CST)

I can live with text that does not agree with my beliefs - let's establish that at the outset. I do not believe that a chiropractor should ever treat an infant unless there is some extremely special circumstance. Just having an MD does not qualify a person to care for an infant either, and I would be appalled if a sick infant was brought to an adult psychiatrist, or an adult radiologist, or a newly minted MD for treatment also unless there were very special circumstances. I have a question. We have spent some time in the article describing this "popping" of joints, do DC also manipulate infants joints to make that sound? (Matt and Gareth-will you sign your posts with the three tilde so it's clear it's you?) Nancy Sculerati MD I've been thinking more about what I object to, from the first I have reviewed the article, my concern is that chiropractic treats systemic diseases and disorders that are not musculoskeletal disorders of the back. In fact, one of my first edits, when I moved from advice on the talk page to working on the article, was to remove that phrasing of what chiropractors treat (musculoskeltal disorders) from the leading sentences of the introduction. I see that it's now there again. It can't be said that DC's treat musculoskeletal disorders (without any further qualification) and also claim that chiropractic treats colic and otitis media. These are not musculoskeletal disorders. Matt, you told me that actually 90% of what DC do is that, and I found nothing in medline to refute it. There is good evidence that manual therapy helps for back pain. But to use manual therapy to treat other illnesses like allergy symptoms is a stretch. It has no rational basis in biology. You can counter that some medical therapies have no rational basis in biology, but that's no real answer. I have been asking you to find a single statement by any official organization of DC's that says it's unethical to treat conditions like early breast cancer with manual therapy, come on Matt, you can't just use your own impression that this is not done as an answer. We cannot approve an article that implies that chiropractic treatment of nonmusculoskeletal disorders is reasonable and accepted, and imply that manual therapy is an accepted treatment for a sick baby without clearly addressing these issues. Do better.Nancy Sculerati MD

Nancy, I apologize, I thought I was just explaining things among pen pals, but I think I understand, I'll try to back up my edits with verifiable and reliable sources, I certainly shouldn't think that I speak for all chiropractors. It would probably help if we all did that. Maybe the article that discusses chiropractors treating breast cancer has a reference that I can follow through to find out the specifics. I've never heard of it. I did find this, that pretty much says exactly what we have, but if you find something that says chiropractic to treat breast cancer, I would like to see it and the doctor who is doing it. Meanwhile, I'll just do my best to quote the source rather than create original research. --D. Matt Innis 20:19, 16 December 2006 (CST)

This is probably a good synopsis (that is not in my words) of straight chiropractic. I think this is important; I quote, "Although there have been attempts to use the terms 'diagnosis' and 'chiropractic diagnosis' to describe chiropractic analysis, these are indistinct and misleading uses of medical terminology which may create false patient expectations. Diagnosis is universally understood to be a medical procedure concerning disease or morbid processes. Because straight chiropractic is non-therapeutic, the term 'diagnosis' is not germane to the practice of straight chiropractic." and I offer in reference to the use of the word treatment; "Those things done to or for a patient for the alleviation of symptoms and /or disease. Since the straight chiropractic objective does not include the treatment of symptoms and/or disease, the term treatment is not appropriate in straight chiropractic." and lastly "There are two types of primary, portal of entry providers: limited and unlimited. These terms refer to the scope of practice relative to the area of anatomy addressed, conditions addressed, and procedures used. Allopathic and osteopathic physicians are examples of unlimited providers, while dentists and optometrists are examples of limited providers. Virtually all state laws are based upon the concept of the chiropractor as a limited, primary, portal of entry health care provider. Straight chiropractic is a limited health care profession, while mixing chiropractic considers itself an unlimited health care profession." --D. Matt Innis 21:11, 16 December 2006 (CST)

For types of spinal adjustments, please see the spinal adjustment article. There are many many more techniques and some especially for children. I won't say no in answer to your question on manipulation for infants, because on occasion it is used, but infants respond very well to much gentler soft tissue techniques that are a lot like mobilization and massage. If you cradle the infants skull and place your index finger so that the PIP joint is just behind the posterior arch of the atlas you can begin a slight caudally stretching massage while slowly tractioning the skull in the opposite direction. Most of the time, you will begin to feel the soft tissue relaxing and the atlas moves forward in relation to the skull. Yes, occasionally the atlas is so fixated it won't move and a very short and gentle wiggle is all it takes. The lymph nodes are easily palpable from this position as well. I agree that meningitis and mastoiditis and encephalitis are all very important to watch for. I checked a three year old this summer who had fallen from a swing. The child had already had tubes and the mother thought it was okay that the ears continued to drain for months. She was on maintenance dose of antibiotics. The mastoids were assymetrical and lymph nodes were very pronounced. We sent her to the best pediatric EENT in Charlotte and she had an immediate mastoidectomy. She is fine today and we have just begun seeing her again with our emphasis on trying to make sure she heals without too much restriction in the upper cervical region. There is no research to back up our protocol, but I think that was the best way to handle it. --D. Matt Innis 22:16, 16 December 2006 (CST)

Most ear infections that have shown up in my office have already been treated for several infections and are even on "maintenance" doses of antibiotics. When a parent asks if I can help, I check the upper cervical region. If there are signs of assymmetry or "trouble spots", I tell them that we can work with that in the manner that I explained above and see what happens. Do you see something wrong with that? So you have to ask this; IF the research were to show that chiropractic care cut the number of children that required tubes in half, would you tell your patients who had children with otitis media to take them for adjustments? --D. Matt Innis 22:54, 16 December 2006 (CST)

My copy of the Mercy Guidelines are at the office. When I get in on Monday morning, I'll check to see if it says anything about treating specific diseases and guidleines for them. I haven't been able to find anything on the net that I think you are interested in. --D. Matt Innis 02:21, 17 December 2006 (CST)

I have inserted references(it added some Kbs) and tried to clean up as much of my original research as possible, but give it another once over to make sure it is accurate and neutral. Gareth, I probably messed up your references, so go ahead and fix them. I really like the reference section and the more I read the history section, the more I realize how good a cleaning you did without losing too much of the reason chiropractors think the way they do. I think we have a pretty good article here that we can grow with. I'll check in again tomorrow afternoon. --D. Matt Innis 02:21, 17 December 2006 (CST)

OK, I've consolidated the references in sections - removed some of the older ones that are redundant with Nancy's, and tightened up the efficacy section especially. I think I like this article even better now, seems fresher and sharper, the efficacy section was pretty ponderous before. I left the single edit that I thought might be contentious until the end and flagged it. Gareth Leng 07:44, 17 December 2006 (CST)

I'm about to go look at what you and Gareth have done, Matt. Before I do I want o answer your questions posed in your last post. I think that the way we use words is very important, ofeten times we even hide our real meaning from ourselves. This is why, when I go through the article, I am likely going to change some phrases to make things plain. It is one thing to talk of "limited" and "unlimited", it's another thing to make plain what that means. From what you write of the case of the draining ears, you did that child a great service. In terms of how we phrase things, you often talk (as do many people including health science professionals) of "avoiding tubes" or "avoiding exposure to antibiotics", yet that's not what you probably really mean. What you mean (if I may take a stab at it) is "getting the problem fixed in the least invasive and most healthy way". This is why you are not upset, but rather proud, that your referral of that little girl to "the best ENT in Charlotte" ended up in major surgery. The goal is not to avoid surgery, the goal is to do the right thing to get somebody better. It's easy for people to think about that in a backwards direction, and get confused about the real goals. My concern is that there does not seem to be an overall regulation of what chiropractors do- by their own professional organizations. That's why I'm looking for some official statement by even one organization about ethics or proper practice. Can you help me find that? regards, Nancy Sculerati MD

Yes, Nancy, I don't expect my edits to be the last word, only one voice in the woods, hopefully clarifying a very complex and diverse profession into 32Kb. I don't expect it to be easy, but your input is essential because your POV is fresh and helps to make this a better article. ;) --D. Matt Innis 08:53, 17 December 2006 (CST)

And I think you have understood properly about "getting the problem fixed in the least invasive and most healthy way". Please also understand that I do not write that way to intentionally mislead, it is just the way I write, and I am so glad to have you and Gareth to clarify it for me. If we were able to sit down and talk through it with a glass of wine (and scotch for Gareth), I'm sure we would have had this all written in an hour and you would realize that our ideas aren't that far apart on anything. I suppose the laws of physics suggests that when an object appears to be working backward, it is just because it is approaching you from a different direction. --D. Matt Innis 09:34, 17 December 2006 (CST)

Regulation

I will be able to look at my copy of the Mercy guidleines tomorrow to see what pages 215 - 218 are (since they are not online). Hopefully they will clarify some. The state boards are the disciplinary bodies, but I am trying to find some more specific guidelines. North Carolina statute for disciplinary action. --D. Matt Innis 18:28, 17 December 2006 (CST)

North Carolina acceptable care statute. --D. Matt Innis 18:50, 17 December 2006 (CST)

Norht Carolina Unethical Conduct statute --D. Matt Innis 18:54, 17 December 2006 (CST)

NC Practice in hospitals --D. Matt Innis 18:55, 17 December 2006 (CST)

NC definition of chiropractic/scope --D. Matt Innis 18:59, 17 December 2006 (CST)

Wisconsin statute --D. Matt Innis 19:12, 17 December 2006 (CST)

Found this from Cancer Research UK about chiropractic care in cancer, might help? [4] GCC [5] GCC Code of Practice [6]Gareth Leng 09:24, 18 December 2006 (CST)

That's similar to things that I am finding here. I have been able to make some copies of some pages of the Mercy guidelines that I will try to find a way to get online. If nothing else I could fax them somewhere. Now I have to get home where I have a scanner:) --D. Matt Innis 10:31, 18 December 2006 (CST)

Nancy, also note the agendas for the FCLB on their website, [7],[8],[9] Is this the kind of stuff you were looking for? --D. Matt Innis 11:20, 18 December 2006 (CST)

Article is fine by me, I've added some of the links above to the FCLB article, and maybe your agendas should be flagged there.Well done Matt, hope you,re pleasedGareth Leng 14:47, 18 December 2006 (CST)

Approval template?

All, shouldn't there be a {{ToApprove}} template here, pointing to the version in the history up for approval?

I note that someone put it up for approval on the main article page, and used a different template. Do please use the above template on the talk page. Let's keep the main page as free of administrivia as possible.

I also note that there are fewer than the stated quorum for approval, but I think in this case--given the people involved--we can fudge a bit. --Larry Sanger 16:05, 18 December 2006 (CST)

Yes, Larry! I saw that, but wasn't sure.. thanks for clearing that up. I'm looking to see whether Nancy needs to make some last minute changes before we all agree to it, so stay close! --D. Matt Innis 16:33, 18 December 2006 (CST)

Matt, I'd like to go through it now. Nancy Sculerati MD

Notes for discussion: 1.pain and other symptoms for repetitive injuries - is this correct? 2. drug part in introduction. Is change acceptable? 3. took out "normal scientific activity" as this does not make sense to me. Put in "progress within the profession". Is this ok?

1. pain and other symptoms from repetative injuries - is this correct?

Very close, but not quite...

the point should be that some subluxations result from one-time traumatic injuries such as lifting or whiplash and some are the result of prolonged postural/repetitive/ergonomic i.e. biomechanical stresses. Also, subluxations are not necessarily painful(especially the latter), but when there is pain, that is definitely part of the subluxation. --D. Matt Innis 23:23, 18 December 2006 (CST)

3. progress within the profession

yes!--D. Matt Innis 23:31, 18 December 2006 (CST)

4. Put in that straights teach against vaccinations - because they do. 5. took out nearly all of the nonspinal stuff because it's not appropriate, too long, and it's said in other parts of the article 6) where's the refernce for the 1996 study in 'Safety'? Need footnote. 7. went back over - studies that show DC efficacy for Rx backpain need references/footnotes. I see that the references are all there, even if the foot notes are not. In it's exact form at this time, it has my approval. Matt- if there is something you can't live with - tell me. Gareth same to you.Nancy Sculerati MD

Well done Nancy, it works for me. I've made some minor formatting adjustments, added a few links. The section on non-spinal treatments that you rightly removed I've transferred pro tem to Critical Views of Chiropractic, and added a stub section on vaccination to that.Gareth Leng 04:33, 19 December 2006 (CST) Looked up ICA (traditional straights) and vaccination - they state that their advice is that vaccination is "not without risk and that therefore "The International Chiropractors Association is supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health." Personally I disagree with this advice, but I am not sure that saying its not without risk is the same as saying it is dangerous? Think this might be an overstatementGareth Leng 04:49, 19 December 2006 (CST)

trouble spots

My list to work with 1. A thorough patient and family history, review of organ systems and a physical examination are all part of a complete evaluation by a DC, however these are all done in a chiropractic manner and are not equivalent to a medical history and physical as done by a physician. --D. Matt Innis 07:43, 19 December 2006 (CST)

Matt, it's different in priniciple and therefore "not equivalent". Find another word or phrase for different besides "not equivalent" that you can agree with, and let's discuss it. Nancy Sculerati MD

Okay, i just took off the italics so it doesn't look like its POV and I can live with it. There are all kinds of levels of physicals and examinations and I'm sure they are all "not equivalent" even among physicians in the same field. --D. Matt Innis 10:03, 19 December 2006 (CST)

Gareth, straights warn against vaccination because they believe it causes problems. Look at the external links Matt provided. There is no reason not to say this plainly. It is true. Nancy Sculerati MD

Yes you are right Nancy, I've added some refs to the critical views articleGareth Leng 10:28, 19 December 2006 (CST)

2. Ethical DCs do not claim to be able to cure cancer, metabolic disorders such as diabetes, or infectious diseases, although they might treat patients who have these conditions, to relieve pain or provide a feeling of well-being.

This statement seems to give me the feeling that there must be unethical DCs as well. Can we find a little better way of saying it without losing the meaning? --D. Matt Innis 10:03, 19 December 2006 (CST)

Agree with Matt here; there are unethical DCs and there are unethical MDs (Harold Shipman was a mass murderer after all) and hopefully theuy get struck off. The codes of ethics appear to make it clear that even if individual DCS have suvch beliefs they are forbidden to advertise them and must advise patiets (informed consent) accurately of risks and benefits according to current knowledge. I've seen lots of contemporary chiro literature stating very clearly that chiro is not a cure for these and none, from credible sources, that claims it is.Gareth Leng 10:28, 19 December 2006 (CST)

3. Nancy, not sure about the references you are talking about in 6 and 7, hopefully those were fixed and that is why i can't find them. --D. Matt Innis 10:15, 19 December 2006 (CST)

4. Traditional straights are skeptical of biology. - Hopefully you guys realize that they really aren't skeptical of the study of 'Life' or 'living matter' (biology), they love to study it as well. They are skeptical of Big Phamaceutical Companie's science. --D. Matt Innis 10:15, 19 December 2006 (CST)

5. Gareth, maybe you can do something neat with the [10],[11],[12] that are in the lead like you've done with the rest. We worked so hard, they make it look trashy. --D. Matt Innis 10:23, 19 December 2006 (CST)OKGareth Leng 10:28, 19 December 2006 (CST)

OK, I'm very happy. Am off to Berlin now, back SaturdayGareth Leng 11:25, 19 December 2006 (CST)

Oh what a life! Have a great time! --D. Matt Innis 11:29, 19 December 2006 (CST)

I want to discuss point 2 above- ethical DCs don npot claim to be able to cure cancer, metabolic disorders... I was so happy when I hit upon that sentence because I thought it briefly encapsulated the whole point about what is acceptable practice in the chiropractic profession for a potential patient to know, without going on and on. Well, maybe I have to do better. Here's what I'm trying to say: Just as no ethical plastic surgeon will promise that they can "make you look just like XXX, the movie star...," There are doctors who practice cosmetic surgery who are not ethical and do make such claims. If I was writing about cosmetic plastic surgery (and I will be) I would be careful to put that in (worded differently) because it is important "consumer knowledge" and it also would accurately fit in to the whole spiel about how a plastic surgeon approaches patient care. I might also say something like "No ethical anesthesiologist will ever promis that there is no risk to anesthesia", or "No ethical surgeon will ever promise that there is no risk to surgery". Now, in the case of chiropractic, there is that fringe of the profession - whether for profit or because of sincere belief, or a combination of the two, imply or outright state their treatment provides fabulous no-risk cures. Just like the cosmetic surgeon who claims that they can promise you the nose of XXX, this is something that goes on but is not easy to prove. And there is no reason to prove it, anyway - that's not the point. The point is to make it clear that such a practice is not acceptable to the ethical majority of the profession, and if you hear that coming out of your cosmetic surgeon's mouth...run! And so that's how I put it. "No ethical...." That particular phrase is typically the way we physicians talk about boundries in our own professional specialties, both about actual procedures and treatments we offer, and about advertising claims, etc. So, here in the talk page, let's figure out a better way to say it. Gareth will just have to log in from Berlin while we languish here at home! Nancy Sculerati MD

Hi guys, I've gone over it again after your adjustments, took out a few things I didn't understand, and adjusted the first para and the second para of the into especially - the lead to tidy up and keep neutral, and the intro because, well, see if it works for you anyway. I think we need to approve this now, basically because every little change from here can essentially trigger a problem inadvertently, it's so easy to introduce a potentially misleading slant without intending to, especially now that the article is trimmed right down.Gareth Leng 15:26, 22 December 2006 (CST)

I'd be willing to accept this version. Anything else is not an emergency and can be worked when other authors and editors arrive, but mostly I think we can offshoot into different articles from here like the biology page, some articles will be more supportive while others might be critical such as we've started. That is the only way we can beat the 32Kb limit for such a large field. --Matt Innis (Talk) 16:31, 22 December 2006 (CST)

I am not against your approving it. However, I do not think that the opening makes much sense. Matt, I don't think we can emphasize subluxations so much without pointing out that only chiropracters know what they are and can identify them, and I don't want to hurt you , but that's the way it is. Also, we are back to claiming that chiropracters treat musculoskeletal disorders, which is very vague and not true. Again, there are chiropracters who treat children (and not for back pain) and assert that they offer total care for men, women, including pregnant women, and children. However we had the wording back when we three agreed, it didn't strike me as so jarring - but here we have an introduction that hides more than it reveals. There is no longer a 32 kb limit- if you look at the forums you will see that Larry Sanger says he favors 40-50 kb as an upper limit. Perhaps we can put back the critical view section, and manage the first paragraph so that it is truly clear and accurate. sigh. Nancy Sculerati MD

Nancy, that was an off-hand remark of mine. If the article seems too long to you or other editors now, that is a much better reason for us not to lengthen it, right now, than any off-hand generalization I might make. As you can see from that forum message, I'm not sure what to think, and we could use some serious thinking on the general question of article length. --Larry Sanger 18:18, 22 December 2006 (CST)

Quote related question

Matt, how does the quote here:

It wasn't so long ago that a college president suggested, "Rigor mortis is the only thing we can't help!"

relate to the rest of the Chiropractic treatment of non-spinal disorders section? The connection is not obvious to me. Sorry if i am missing the context here. Chris Day (Talk) 17:47, 22 December 2006 (CST)

Chris, this is a very good question. This really goes to the heart of the medical/chiropractic debate. The person that made that statement was Sid Williams, president and founder of Life Chiropractic College in Atlanta Georgia which grew to become the largest chiropractic college in the 1980s. He was known for his enthusiasm and gospell-like speaches and was a strong advocate for tradtional straight chiropractic. He is a contorversial figure even within chiropractic. The short version is that he made this statement during a series of seminars and it raised the ire of chiropractors and medical doctors who would have liked to see chiropractic limited to just musculoskeletal and spine pain. But, as with any statement that causes controversy, there is an element of truth that chiropractic care might well have value for anyone who is still alive, whether they have spine pain or not. As a side note, Life chiropractic soon lost its accreditation status and is still embroiled in a political controversy to restore its status.

The statement that we make strikes me as being accurate, though perhaps the title of the section could reflect what we say a little better. Perhaps you or Gareth can take a look at that. Hope that hepls. --Matt Innis (Talk) 08:33, 24 December 2006 (CST)

Intro again-

Sorry to keep coming back to this but it is probably the most important part of the text with respect to 'catching' the reader. At present Subluxation seems to dominate the section to a disproportinate degree. How about something alomng the lines of:

Chiropractic is a complementary and alternative health care profession that uses manual therapies on the spine and extremities with the aim of improving health. While chiropractors treat all types of musculoskeletal problems, their defining theory is that they can affect body function by locating and correcting what they call subluxations of the spine. These are distinct from medical subluxations. Chiropractors view subluxations as the first stage of degenerative changes, such as arthritis, and believe that these are misaligned, fixated or unusually mobile vertebrae. Subluxations are treated with procedures called spinal adjustments that are intended to help improve body posture and joint mobility.

I moved a few things around and deleted the bits below.

that, by interfering with the nervous system, can affect health adversely in diverse ways.

This seems too detailed.

They locate these subluxations by carefully examining the back. When they believe that they have located a subluxation, they

Again, this is too detailed for the intro.

Also there should be a link to medical subluxations so readers can contrast them, if they chooose, i hope these comments are useful to you. Chris Day (Talk) 17:58, 22 December 2006 (CST)

That is certainly more succinct and says the same thing. We could use this subluxation for now until we get something together. --Matt Innis (Talk) 00:08, 23 December 2006 (CST)

There is a problem here that we keep getting stuck on. Your intro seems clear and succinct and is technically accurate as Matt says, but it appears as Nancy might say, to elide over the issue that divides MDs and DCs - i e that DCs think that subluxations are the cause of some ailments that MDs regard as unrelated to the spine. Hence the two sentences that you suggest deleting (stressing the indirect effects of nervous system interference). I think the emphasis is on subluxation because this is the critical source of the disagreements between DCs and MDs. However for a lay reader this will all possibly pass by them anyway.Gareth Leng 07:41, 23 December 2006 (CST)

Let's try this

Okay, after reading all of the above that was posted today, and since I rearranged the article and made some changes, how about Nancy you take a shot at it to get your POV back that I may have watered down. Then I will make some comments here on the talk page. Then, Gareth, if you can take Nancy's stuff and my comments and Chris's concerns and put them together from a scientists POV and lets see what we end up with. --Matt Innis (Talk) 00:03, 23 December 2006 (CST)

Looking at the content and the content of the version we were all happy with, it's hard to see much difference except in subtle things, like the order of things. I've shifted the definition of subluxation bit back to the front. I have the feeling now that we're reading the same things but reading different things into them, so I was a bit confused by Nancy's comments at first, as I couldn't see what was different, but I do see some places that can be read in ways that are wrong.Gareth Leng 04:36, 23 December 2006 (CST)

Sorry guys, I saw I messed up the Talk page inadvertently before skipping off to Berlin - sigh Gareth Leng 04:56, 23 December 2006 (CST)

yes, on reading over, the article looks ok. Nancy Sculerati MD

Looks good to me, moving that section back to the intro did make a difference. I think it works for me, too! Nancy, please take one more look, it needs to satisfy your concerns, too, otherwise when this goes live, no-one is going to give credibility to CZ. Just keep in mind that most of my problems will come from chiropractors themselves, so most of the edits I make are really trying to accomodate as many of them as possible in a respectful manner, otherwise they, too, will think this process is biased. I'm going to go ahead and stick the tag back on and we can fine tune from here. Sound good!!!! Meanwhile I've got some shopping to do if I am going to live past christmas;) --Matt Innis (Talk) 08:41, 23 December 2006 (CST)

Moved approval template to make it more visible (was originally here)--ZachPruckowski 01:30, 26 December 2006 (CST)

Can someone put the right version in the description? :) --Matt Innis (Talk) 08:49, 26 December 2006 (CST) I found it! --Matt Innis (Talk)

I also changed the date to the 26th to give everyone a chance to look at it again. --Matt Innis (Talk) 07:45, 24 December 2006 (CST)

Folks, please rely on another sysop to do the work of approving this article. Any constable should be able to help. Needless to say, I trust you. --Larry Sanger 23:12, 25 December 2006 (CST)

Ok, I'm working on making this approved. Give me a bit, I'm new to this :) It looks great, everyone. -- Sarah Tuttle 13:40, 28 December 2006 (CST)

Tada. Consider yourselves approved. Hurrah. Someone want to make a shoutout to CZ-L about the new approved article? :) -- Sarah Tuttle 14:02, 28 December 2006 (CST)

Ah, beat me to it, Sarah. :) Looks like a great article. --Mike Johnson 18:08, 28 December 2006 (CST)