Commentary: Philosophy/Research: Are chiropractors asking the right questions? Virgil Seutter, D.C. Chiropractic Resource Organization (chiro.org). 19 Aug 2000.
I sometimes wonder whether chiropractors are asking the right questions about their profession. Presuming, of course, that the philosophy is correct, then one might assume that our research is focused in the right areas. All we need, according to Cheryl Hawk, D.C., PhD., are more "case reports and observational research" (1).
Of course, promoting and discussing philosophy is something chiropractors can't get enough of. One would think that once a theory has been recognized as half way valid (a consensus thing, as in the chiropractic "adjustment" and its "vitalistic" ramifications), that one need not pursue a discourse that merely serves to consume more time and energy; got better things to do. (2) Then, again, perhaps its got to do with something we haven't really acknowledged, like, maybe, we really do have a problem. Chistopher Kent, D.C., F.C.C.I., would call it an "identity crisis." I'm not quite sure what this means, like, do I do therapeutic maneuvers or non-therapeutic maneuvers when I wrestle the spine in its various contortional maneuvers? It's really too much for my brain to fathom. I'm really hoping that I'm doing something therapeutic, after all, that's why the patient is seeing me. Then again, if I'm not doing anything therapeutic, why am I doing it? But, that's why the philosophy; it's the philosophy that reassures me that I'm doing something worthwhile, even though the research hasn't quite pinned it down. Kent further relies upon Morinis to support his argument for philosophy that "Having already begun to lose the exclusive practice of spinal manipulation to allopaths and physiotherapists, only the chiropractic philosophy significantly distinguishes the chiropractic practitioner (3)". I'm befuddled.
Joseph Flesia talks about chiropractic as a psychotic venture, from political medicine's perspective, that is. It's an attempt to add complexity to an already complex subject. When the discussion elaborates upon the vitalistic, subluxation model as an "open ended" system in comparison to the allopathic model as a "closed ended" system, (4) I'm not so sure I can agree. The idea of an "open ended" versus "closed ended" system is really just conveying an idea convenient to differentiate two separate models of activity. Is it something new, relevant to our examination of chiropractic? I don't think so, just another way of prolonging the agony of dualism and its rejection of some of the more profound observations of nature (5). It elaborates that, "In a Descartian sense, the dualism that represents the "stuff" and the "stuff'n" suggest that a direct link from material to nonmaterial is not possible (6). It really doesn't solve our problem, just prolongs the agony of more time wasted in rhetoric.
Further discussion of dualistic perspectives is elaborated upon by Robert Mootz as he "...examines this model building by defining a Type A versus a Type B theory. Much of this overlaps into definition that has been around awhile but he attributes the perception of 'molecular' and 'contextual' healing to Dean Black as defining a characteristic between traditional and alternative approaches to health care. Black emphasizes the molecular model as a physiological reaction to the bioengineering model in which causal relationships appear as a reducible form to 'one cause, one effect' as a root cause to disease. In contrast, the contextual nature of disease may be viewed as a physiological reaction in response to a biopsychosocial encounter (7)."
Perplexing: the Adjustment and Chiropractic Techniques to Affect the Subluxation
Perhaps I should just be content with William Meeker's observation that challenges still exist for the profession. That "subluxation is related to health, health is related to adjustment; and adjustment is related to subluxation" is a bewildering statement. That "these three concepts and their interlocking relationships provide an umbrella for a chiropractic research agenda" (8) is perplexing, at least to me. What I can't seem to understand is the nature of the philosophy with the nature of the protocol, i.e., the act of manual application, itself, and it's purported effect as an object for research. A declarative statement to support the purported effect of manipulation, or chiropractic and the adjustment, is not sufficient, in my opinion, to explain the various techniques that exist within the chiropractic profession. It is, in part, one reason chiropractic must resort to philosophy to explain its merits. It may also be that it further complicates the ability to establish an evidence-based data base since adjustment, alone, is no longer a primary directive in chiropractic protocol; that multiple techniques contribute to the end-result of a chiropractic encounter (9).
The possibility that the chiropractic philosophy is not sufficient to explain chiropractic contributes to the disarray and disunity within the profession. Emphasizing the philosophy as an answer when the philosophy and the philosopher are not asking the right questions is, indeed, a disservice to the profession. Indeed, an EXTREME disservice; for, it effects the way in which the researcher will, in turn, ask his questions and pursue his research. The philosophy handicaps the ability for the researcher to formulate his inquiry. That disservice ultimately will effect the field doctor who will be prevented from improving upon his art or permitted to understand why his art performs in the way it does.
For those who would indulge in philosophy, or in research, asking the right questions may be more important then evaluating the outcome of the practitioner who, committed to a protocol that he has already accepted (whether manipulation, acupuncture, AK, SOT, etc.), performs his routine with minimal question of validity. His intent is to prove that it works. Indeed, a falicious intent since the practitioner has no real understanding of "why" his protocol works to begin with...
Indeed, the "real" question --- and the "right" question --- seems to escape our attention. Chiropractors hardly notice that, in the attempt to condone or condemn a protocol (whether manipulation, muscle testing (10), or leg length inequality (LLI)) (11,12,13,14), the chiropractor essentially misses the point; that, in all the ballyhoo about technique, a key observation has been obscured by the focus on the "action" of a protocol rather than the sequence of events that lead to that action. In other words, the ability to study a chiropractic technique may be dependent upon something that actually --- precedes --- the protocol (or the act of differentiation in the protocol).
For those not yet grasping the implications of my statement, the ability to study muscle testing may not be in the observation that a muscle weakness is noticed but that something --- precedes --- that act of muscle testing; the ability to study LLI may not be in the observation of a change in leg length but that something --- precedes --- the observation of LLI.
For the moment, however, we must speculate and dream up some way to demonstrate that, in principle, it could be possible not only to demonstrate that both muscle testing procedures and LLI are an illusion but that both may contribute to our evaluation of technique development within the profession. It may also be possible to demonstrate that muscle testing and LLI provoke the same mechanisms of reaction; that, in principle, there is no difference between muscle testing and leg length checks.
For the moment we must use a thought experiment to demonstrate possible outcomes from either muscle testing or leg length checks. Indeed, since no data has been published on this observation, it will be the prerogative of the reader to perform the experiment and thereby gather his own data. Furthermore, it will be for the researcher to further pursue the experiment , if interested, and publish the data as part of regimented study. I merely provide a glimpse into what could be possible.
[That which precedes any observation of change in the act of differentiation (i.e., muscle weakness or leg length change) involves "touch." How touch enters into the information processing networking within the body could be possible; that it may contribute to an understanding that chiropractic may be tapping into consciousness as a contextual experience of its environment through neurological mechanisms (15). Speculation would suggest that we could be dealing with a self-referencing system. This self-referencing system, however, unfolds into a communication system of information processing that conceives the world as a contextual experience. While these mechanisms have been isolated as dualistic characteristics of body function (mind/body relationships), the implication of an "innate" function as a transcendental experience may be nothing more than interpretation of contextually translatable experiences. The transistion from philosophy to theory to research will be dependent upon our ability to transcend our present constructs in thinking and to demonstrate that some of our observations in protocol may need revision.]
The hypothesis that muscle testing procedure and LLI are, in principle, similar by utilizing the provocation of "touch" to initiate the response has not been seriously considered in the research into manual contact therapies. This article will attempt to provide a means whereby demonstration of the similarity may be possible. Much of the format for challenging the tactile provocation to a topographical area of the body was derived from previous attempts to topographically analyze the body surface and correlate the topographical area with various levels of the spinal cord. These areas of body surface became spatial reference points that, through the use of computer analysis into probability relationships, could be linked to various levels of the spinal cord (unpublished data). In essence, it was a pilot study to extract data that could be correlated by computer of designated spatial contact points to a level of the spinal cord.
While the data reveals little by way of meaningful correlation, by correlating computer relationships into probability analysis, some insight into the analysis became more apparent. However, it was not until treatment application was initiated by following the computer data base that remarkable changes occurred to provide further insight into whatever it was the data was revealing. The methods used were confined to the use of a manual instrument (activator) so I could confine the manipulative intervention within the area indicated by the computer data.
A problem, however, was in finding methods to speed up the process and to eliminate the actual use of muscle testing for reasons of convenience and to reduce the "showmanship" nature of the testing. Since I felt that both muscle testing and LLI were, essentially, utilizing the same principles, I began to use the iliac crests as a landmark reference point in place of actual LLI. The surprise was that I could use this reference point in place of muscle testing or leg length deviations and that it correlated with isolated tests using either muscle testing or leg length evaluation to identify with spatial reference points in a topographical analysis of the body surface (in A.K., the use of therapy localization (16), etc.). This protocol provided insight into the role of touch in a self-referencing examination of the body and the manifestation of illusion in evaluating possible leg length alteration.
Vague references occasionally arise that suggest that muscle testing and leg length inequality is demonstrated within a window of time, usually one minute. This window must be respected in evaluating the iliac crests when standing.
Stand behind the standing subject. Place both hands on the iliac crests to determine whether inequality exists. Wait one minute to evaluate differences in the iliac crests. Since this was more of a feasibility study, visual representation of change was noted rather than millimetric change.
The morphological changes from cellular genesis to embryo began as a characteristic of chemical reaction - diffusion mechanisms. The inquiry into chiropractic technique may need to approach a non-linear dynamic that involves complexity science and information theory, hebbian learning and plasticity. [animal coat patterns/markings can be generated using a reaction diffusion principle in computer analysis, etc. Biomathematical applications based on the principles of Turing space (as a form of aberrant spatial patterning) may provide information for understanding provocative muscle testing procedure and its relation to therapy localization contact points.]
Mathematical Biology I J.Mathematical Biology
Mathematical Biology TextOne of two approaches may be observed as the observer views the subject from the back: 1) the iliac crests will be level or 2) the iliac crests will appear to deviate or become unequal with one of the crests appearing to be elevated in relation to the opposite crest:
- 1) if the iliac crests appear level, have the subject touch with finger tips of one hand the various contact points in the diagram at the left. Usually one of the contact points will demonstrate a change or alteration in the level of the iliac crests with one crest becoming unequal in relation to the opposite. Wait approximately one minute before evaluating and/or moving to the next contact point.
- 2) if one iliac crest appears unequal or elevated in relation to the opposite, have the subject touch with the finger tips of one hand the various contact points in the diagram at the left. Usually one of the contact points will demonstrate a change or alteration in the level of the iliac crest with both crests becoming equal to each other. Wait approximately one minute before evaluating and/or moving to the next contact point.
The results of the spatial challenge to the ventral topography of the body appears to coincide with challenges in muscle testing protocol. Leg length inequality changes, because the patient is either prone or supine, will not always coincide. This later finding is not disturbing, since it appears that movement of various parts of the body (head flexed, extended, or lateral bending) will change the reflex nature of the contact points (17). One might speculate from this latter finding that the nature of reflex communication within the body might be viewed as alterations in information processing in a self-referencing, self-organizing complex system.
The conclusions are based on changes that appear as an alteration in a reference point (i.e., iliac crest inequality) when contact is made to a spatially referenced point on the ventral surface of the body. Since these reference points and spatial contacts will vary with position changes, the speculation that a communication networking could reflect the nature of reflex activity is a stronger argument for the possible ability to quantify a self-referencing system through mathematical correlation. The inference would follow that this self-referencing system of reflexes could parallel the cognitive system of the body, i.e., consciousness. However, the intent of the experiment was to demonstrate that both muscle testing and leg length inequality may be illusions. By using the iliac crests as a reference point for apparent leg length inequalities and using spatially designated topographical contact points that reference similar points in applied kinesiology therapy localization, it becomes apparent that leg length will appear to change as various spatial contact points are challenged. This implies that viewing a neutral contact to the iliac crests may not be accurate or essentially significant and/or may be an illusion. This is implied since when the subject contacts a spatial reference point on the ventral surface of the body, the iliac crests will shift either from equal to unequal or from unequal to equal. This means that if the subject unintentionally contacts a part of the body while the observer is attempting to evaluate the postural iliac crest, it may be possible to distort the finding, i.e., the altered iliac crest could be an illusion and not a real representation of true posture. A further insight into the appearance of a leg length inequality may be due to changes in rotation of the pelvis in relationship to innominate muscle changes. A speculation would suggest that this rotation may be due to alterations in muscle support to the pelvis, etc. that provide the appearance of an alteration to leg length. However, the nature of the mechanism strongly suggests an illusion and one that will vary with the contact references being used. Whether these protocols of muscle testing and LLI can be used in constructive ways is speculative. If, in principle, these protocols elicit responses that correlate to a self-referencing system, then possibilities may exist to tap into the self-referencing consciousness of the body.
How chiropractic will view its philosophy and its research will depend upon how well it will ask the questions necessary to examine itself. If philosophy cannot contribute to innovative ideas/theories, then the research will find difficulty in developing novel ways to construct experimentation into the chiropractic experiment. Indeed, until chiropractic sheds its philosophy, develops its theory, and expands upon research that integrates the mind/body connection, chiropractic will remain an experiment in futility. My observations are provided in the spirit of speculation, to stir your questions and contribute to creative thinking.
Virgil J. Seutter, D.C.
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