Were pioneer chiropractors clinically naïve? Certainly. All physicians of past ages were when compared to those with having the knowledge of today. Were they effective? Many more times than not by applying, through experience or intuition, an efficient modus operandi for the times. At one period, not a single state licensed a chiropractor. Now, all states and many foreign countries do. This was not a gift. It was well earned, often by great personal sacrifice --sacrifices that have been trudged by the avaricious, the pseudointellectuals, and the philosophically deluded.

Chiropractic became firmly established in the 1920s--mid-1930s: impetus initially followed excellent results during the great flu epidemic after World War I. Before the discovery of antibiotics in the 1940s, many found chiropractic the treatment of choice for pneumonia.

Up to the mid-1960s, most chiropractors considered themselves as in general family practice, treating such complaints as headaches, sinusitis, indigestion, colds, pharyngitis, myalgia, neuritis, hypertension, arthritis, common childhood infections, allergies, etc. Both the NCA and ICA published a large variety of "health tracts," describing chiropractic management of common visceral dysfunctions. There was little desire to exclusively treat acute sprains or strains, and rarely was the topic mentioned in chiropractic literature. On occasion, a DC would gain fame in treating race car drivers, a professional baseball or hockey team, etc. However, this was rare and looked upon by colleagues as that doctor's hobby.

The 1930s was the era of the great depression. About a third of one's practice could not afford the DC's $1--$3 office fee. A dollar a day was considered a good wage for manual labor. This was commonly accepted for reimbursement was made by community love and respect. "Poor people get sick too." If a person could not work, his family did not eat. This was an era in which results had to be achieved quickly and cheaply if a doctor's reputation was to be established. It invariably was.

This was the time in which house calls were made during blizzards, often without payment, and the threat of jail for practicing medicine without a license hung like a dark cloud over every DC. These were the DCs that built chiropractic's heritage. Today, their dedication and sacrifices have been forgotten or ignored and replaced by too many preoccupied with "marketing" gimmicks. So sad.


Emphasis Herein

Were the technics described herein practiced by all pioneer chiropractors? No. As in any profession, some were highly skilled, some possessed moderate skills, and a few exhibited poor skills. Nonthinkers would only do or apply what their chosen mentor approved. Also, as in any profession, some tabled their knowledge to accommodate the time demands of a high-volume practice.

The approaches presented here represent the methodology of the "Cream of the crop." It were these that spurred the profession to its current main-stream position in society despite mammoth antichiropractic forces.

     The Pioneer's Major Foes

Few living today can appreciate the gigantic obstacles overcome that were built from both within and without. The majority of obstacles within were those constructed by B. J. Palmer who personally lobbied state legislatures against chiropractors being licensed as doctors of chiropractic; lobbied that chiropractors do not diagnose, only analyze (via the neurocalometer instrument, a surface-heat detection device that must be leased from him); lobbied that any chiropractor who adjusted any patient's below the axis and other than when laterally recumbent was a fraud, and lobbied that the use of physiologic modalities perfected by chiropractors, long before there was a profession called physiotherapy, was not chiropractic.

B. J. Palmer's philosophy even denied the existence of an autonomic nervous system, and his ADIO (above down, inside out) presupposition ignored the body's complex sensory system. He viewed the nervous system as a one-way street and employed a "foot-on-a-hose" analogy to describe nerve compression, though his father emphasized nerve irritation at the intervertebral foramen (IVF). On the younger Palmer's side were money from the first radio station west of the Mississippi River and blind devotion by his disciples. Those that dared challenge his dogma were labeled unprincipled, chiropracTOIDS, or medipractors. He fought against expanding Palmer Chiropractic School's 18-month (3 years of 6 months) curriculum to his death in the early 1960s.

It is my belief that if the profession had divided itself in the 1920s into two professions, those following the basic philosophy of D. D. Palmer and those of B. J. Palmer, both professions would be further advanced today.

     David Faces Goliath

"If you think it's tough now, wait until the opposition arrives."

Of course, the pioneers' other major foe (externally) was political medicine who controlled many powerful politicians, media editors, influential columnists, state health-related agencies, insurance companies, etc. Chiropractic was a minority profession and B. J. Palmer's power to divide the profession (AMA supported according to "Wilk case" discovery) added to its weakness in combating the formidable forces of political medicine.

     The Pioneer Era

Were pioneer chiropractors those that practiced between 1896 and 1926? No, in this author's opinion. I define the pioneer era of chiropractic to extend from the late 1800s to the very early 1970s. Once most states had licensed chiropractors, once many insurance companies and state workers compensation boards recognized chiropractic care, once the federal government included chiropractic under Medicare, professional focus, and rightfully so, shifted to scientific verification. Here the art of chiropractic took a secondary role. Unfortunately, some believe even more so than the subjugation of manipulative arts within osteopathy.

Following is a July 2000 comment made by Richard Gillespie, DC, a member of the Board of Texas Chiropractic Examiners. It is in response to my thoughts on developing this monograph.

     Educational Perspective

Most of us have witnessed practitioners who have turned an adjunctive tool into a primary therapy exclusively. We see this at times with acupuncture, physiotherapy, therapeutic nutrition, psychotherapy, herbology, and those who have made one region of the spine their master rather than a servant. Such a limited viewpoint of the scope of chiropractic health care, unfortunately, does a disservice to the profession, the practitioner, his or her patients, and the public.

The fault for this misdirection must be placed on inadequate or shunted training. No logical person would forsake a primary therapy for an ancillary therapy if he or she had confidence and skill in its application. Articular therapy is no exception.

This paper briefly defines certain general underlying principles that underlie almost all chiropractic adjustive technics proved by time and patients' joy. Some may be new to the reader, yet their basis is as old as chiropractic itself.


The Factor of Time in the Clinical Approach

To produce an effective articular adjustment, it is first necessary today to evaluate the degree of joint motions and end plays present if possible. Whatever corrective procedure is used, Hooke's law should be remembered: The stress applied to stretch or compress a tissue is proportional to the strain, or change in length thus produced, if the limit of elasticity of the tissue is not exceeded.

Adjustive objectives are generally achieved by dynamic manual articular mobilization unless such a technic is contraindicated in a specific situation. Obviously, one would not apply a dynamic force over extremely porotic bone, a fracture, an abscess, a tubercular cyst, a fusion, or a malignancy, for example; nor would it be applied over acutely inflamed tissue or splinted muscles if the doctor expects the patient to continue the treatment plan.

I approach the subject of chiropractic articular correction as a nonincisive surgical procedure, a "chiurgical" art. Astute application takes time. It takes time (1--3 minutes) to assure proper patient positioning, conditioning, assure that the intended line of drive is parallel to a particular patient's facet design, assure that the safest and most efficient and painless point of contact is selected, and assure that the proper impulse velocity and depth have been predetermined according to the circumstances at hand (eg, patient age, size, development, individual pain threshold, underlying pathophysiologic status, table design, etc.).

There is no doubt that sufficient time must be taken to assure that adequate examination is made and preadjustive therapy is applied to render the tissues involved to be more receptive to the adjustment (eg, tissue plasticity, elasticity, and flexibility) and that adequate postadjustive therapy is applied to enhance the healing process (eg, neurocirculatory processes and pain control). In addition, traumatized and pathologic connective tissues characteristically have poor nutrition, low endurance, and high biomechanical fatigue properties. These considerations form a substantial part of the scientific foundation of our art.

Neuromusculoskeletal tissues are organic viscoelastic substances. The critical factor in viscoelastic stability involves both load and a time element; ie, a viscoelastic substance can resist a certain load for a period and then fail without the load being altered. All musculoskeletal structures, thus, have a time-dependent stability factor, which is usually structurally adapted to in living tissue if the time element is prolonged. We witness this in bone with the trabeculae redesign from chronic overstress according to Wolff's law. What is true for bone is true in all viscoelastic substance to a variable degree.


Below are some pioneer thoughts:

Terminology

Because of tradition and not semantics, the term technic was commonly used in the profession to describe a procedure utilized within a manual adjustive procedure. The word technique was used relative to other procedures. Regardless, a technic or technique is only a method, one method of many, options that must be adapted to the situation at hand, clinical judgment, and personal preference. This is true for those technics described in this text or within any other book or seminar.

Chiropractic treatment or therapy should be differentiated from chiropractic technic, which is one form of treatment. Treatment (case management) often includes the application of a primary method plus all ancillary (supportive, adjuvant) procedures incorporated to accomplish the clinical objective. Procedures in chiropractic often include articular therapy, myotherapy, meridian therapy, electrotherapy, spondylotherapy, heat, cold, traction, nutritional supplementation, diet control, therapeutic exercise, biofeedback, supports, magnetics, psychotherapy (including therapeutic suggestion and psychoneuroimmunologic enhancement) or other forms of counseling, and other forms of justifiable therapy in the most efficient manner.

Conservative treatment is that designed to avoid radical measures or procedures; rational treatment, that based on knowledge of the disorder and the action of the remedies applied; empiric treatment, any means by which experience has proved to be beneficial; prophylactic (preventive) treatment, that designed to prevent occurrence of a disease/dysfunction; and palliative treatment, designed to relieve pain and distress without an attempt to cure (usually applied to strength-reducing factors).

The primary goals are to relieve direct/indirect causes of pain (a physiologic signal), enhance neurocirculatory integrity, improve articular relationship and function if necessary, influence other physiologic processes that would augment the healing process, and minimize disability as far as possible. There are, of course, times when a usually ancillary procedure is used as a primary therapy such as in the application of coolness to a burn or initially to reduce the swelling of a sprained joint.

The term adjustment simply means to alter current status or to fix or fit; to bring into correct relationship, to regulate, conform or adapt; Almost any thing, thought, process, level, habit, lifestyle, etc, may be adjusted.

Although the articular "adjustment" has always been the foundation of chiropractic therapeutics, few have tried to define it and most who have were met with severe criticism. A chiropractic adjustment, according to Sandoz, is a passive manual maneuver during which the three-joint complex (IVD interface and apophyseal joints) is suddenly carried beyond the normal physiologic range of movement without attacking the boundaries of anatomical integrity. Swezey, an allopath, defined a dynamic chiropractic adjustment as the high-velocity short-arc inducing passive movement of one articulating surface across another.

Few would strongly object to either of these limited attempts to define the purely structural effect induced; ie, if the objective is solely to mobilize a fixation or reposition a subluxation. Unfortunately, such purely mechanical concepts are limited; eg, most importantly they fail to consider the induced neurologic stimulation on the cord, root, axoplasmic flow, and mechanoreceptors of the area and the local and remote "spillover," facilitation, or dampening effects of such stimuli on connected tracts and interneurons.

Besides its effect on the contents of the intervertebral foramina (IVFs), a vertebral segment's position in fixation is another important factor. Vertebral tilting as seen in disorders with lateral disc wedging alters the relationship of apposing articular surfaces to produce a change in the direction of compressive forces on these joints. In contrast, severe fixed rotation produces jamming compression on ipsilateral facets and contralateral facet separation.

When continuous compression is applied to any joint, arthritis followed by erosion and exostosis and its sequelae can be expected. Contralateral foramina elongation can equally produce noxious effects by the increased tensile forces upon foraminal contents, especially if adhesions have formed between bone and sheaths.


What Makes Chiropractic Unique?

There is a trend to lump what a chiropractor does during an articular "adjustment" under the general category of spinal manipulative therapy (SMT). This is a term originated by allied health professions that was rarely seen in chiropractic literature before the late 1970s. I am uncomfortable with such a generalization because I believe that what a chiropractor does (or should do) is far removed from the manipulation procedures commonly taught to physiotherapists and many osteopaths. Other health-care professions typically apply little more than passive attempts to increase a restricted gross range of movement of a joint by stretching contractures. Dr. Roy Hildebrant dropped the traditional term "adjustment" for "manipulation" as the first editor of the JMPT, and the term, unfortunately, became generally accepted.

While the descriptor SMT may be appropriate for some low-velocity extraspinal adjustive technics or the application of a stretching maneuver to improve a joint's gross range of motion, it can be argued that its use is a clear misnomer in most instances when applied to the application of chiropractic during spinal therapy. The function of a robot can be explained in electrical and mechanical terms. This is not true for the human organism. Today's purely mechanical or neurochemical explanations will not suffice for every situation occurring in or by a biologic organism.

More than 30 years ago, Levine had the foresight to warn those who defined the chiropractic adjustment solely in structural terms without considering the neurologic overtones involved: