Chiropractic is the Practice
of Mechanical-Based Patient Care
Using the Hands

In her book, Molecules of Emotion, The Science Behind Mind-Body Medicine, Candace Pert, PhD, notes that people’s (and animal’s) emotions are observable in their posture and facial expressions (1).

•••

This is not a fictitious story, it is real; the names have been changed.

Mr. Smith was 81 years old. He had retired from working as a high school math teacher at age 65. His wife of 40 years had died 3 years prior, when he was 78 years of age. Their children and grandchildren were not geographically close, and he rarely saw them.

Following his wife’s passing he had sold their family home and moved into a rented apartment in the downtown region of a large western US city. He no longer drove, and he no longer owned a motor vehicle. The closeness and conveniences of living downtown suited him, but he had to rely on public transportation for all activities outside of the downtown area.

Dr. Richard was a chiropractor with the highest reputation. He had been in practice for decades. He was smart, experienced, intuitive, and well educated. He was an excellent diagnostician and an excellent adjuster (specific line-of-drive chiropractic manipulation). His clinical specialty was mechanically-based musculoskeletal syndromes. His clinical practice was 100% referral based.

Dr. Richard’s clinical practice was in a suburb about 30 minutes east of Mr. Smith’s residence, somewhat longer when relying on public transportation. Mr. Smith had been referred to Dr. Richard for chiropractic care. After his first consultation, examination, and adjustment, Mr. Smith was happy to make the public transportation journey to and from Dr. Richard’s clinic for ongoing chiropractic care.

Mr. Smith would always arrive significantly early, often by nearly an hour, for his appointments with Dr. Richard. He was also dressed impeccably, in a suit and with a tie. Mr. Smith would sit patiently in Dr. Richard’s waiting room for his appointment time.

All of Mr. Smith’s appointment visits with Dr. Richard were essentially the same. Dr. Richard would listen to Mr. Smith explain his musculoskeletal concerns. Dr. Richard would then examine Mr. Smith’s areas of concern with a combination of static palpation of muscles, tissues, and alignment, motion palpation for symmetry and magnitude of joint movement, and on occasion, when warranted, a few appropriate orthopedic and/or neurological tests. Following this assessment, Dr. Richard would deliver appropriate mechanical-based care, primarily hands-on tissue work and chiropractic adjustments.

After each visit, Dr. Richard would advise Mr. Smith about possible continuing causes for his musculoskeletal complaints, such as sleeping positions and/or postural positions, as well as other activities of daily living (lifting, bending, stooping, etc.), and they would discuss options for corrections. Dr. Richard would often recommend one or more home exercises, and follow-up on previously recommended exercises. Finally, a recommendation for a return visit would be given.

The frequency of Mr. Smith’s care with Dr. Richard was quite standard for musculoskeletal concerns. Initially, treatment frequency was three times per week. As improvements occurred, Dr. Richard reduced the frequency to twice weekly, then once weekly, then to once every other week.

Dr. Richard was aware of the distance and hassles for Mr. Smith with using public transportation to get from the downtown location to his office in the suburbs. Initially, he assumed that Mr. Smith would be happy with both his improvements and with the reduced frequency of patient visits, but his observations suggested a different story.

We’ll pick up this story toward the end of this article.

•••

Allopathic medicine is commonly known as modern, Western, or conventional medicine, where medical doctors (physicians) diagnose and treat diseases using drugs, surgery, and radiation. Allopathic medicine is also referred to as biomedicine, mainstream medicine, or orthodox medicine.

In contrast, chiropractic is mechanical-based patient care, and it involves touch. In this context, touch refers to the tactile sense, where a chiropractor uses their hands to contact a body part to perceive its texture, temperature, position, alignment, motion, etc., and then to introduce a force to elicit improved mechanical function. Mechanical-based approaches to patient care, including spinal manipulation, have existed for thousands of years (2, 3).

Spinal manipulation has been practiced in many parts of the world, primarily to treat musculoskeletal disorders. Ancient evidence for the use of spinal manipulation has been documented in Bohemian (Czechoslovakia), China, Egypt, England, Finland, Greece, India, Japan, Latin America, Norway, Russia, and Wales.

In 2007, a study published in The Journal of Manual & Manipulative Therapy notes (3):

“Manipulative therapy has known a parallel development throughout many parts of the world. The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE.”

“Historically, manipulation can trace its origins from parallel developments in many parts of the world where it was used to treat a variety of musculoskeletal conditions, including spinal disorders.”

“It is acknowledged that spinal manipulation is and was widely practiced in many cultures and often in remote world communities such as by the Balinese of Indonesia, the Lomi-Lomi of Hawaii, in areas of Japan, China and India, by the shamans of Central Asia, by sabodors in Mexico, by bone setters of Nepal as well as by bone setters in Russia and Norway.”

“Historical reference to Greece provides the first direct evidence of the practice of spinal manipulation.”

“Hippocrates (460–385 BCE), who is often referred to as the father of medicine, was the first physician to describe spinal manipulative techniques.”

“Claudius Galen (131–202 CE), a noted Roman surgeon, provided evidence of manipulation including the acts of standing or walking on the dysfunctional spinal region.”

“Avicenna (also known as the doctor of doctors) from Baghdad (980–1037 CE) included descriptions of Hippocrates’ techniques in his medical text The Book of Healing.”

The primary reason (93%) patients go to chiropractors is for the management of spinal pain complaints (4). Specifically, 63% go to chiropractors for low back pain, and 30% go to chiropractors for neck pain.

Modern chiropractic care is primarily mechanical-based care. The distinguishing difference between the mechanical-based care of chiropractic as compared to other mechanical-based disciplines is the spinal adjustment (5, 6, 7, 8).

The spinal adjustment is a form of manipulation that is delivered in a specific line of direction. A good description of the chiropractic adjustment is found in the publication by orthopedic surgeon William H. Kirkaldy-Willis that notes (7):

“[Chiropractic] spinal manipulation is essentially an assisted passive motion applied to the spinal apophyseal and sacroiliac joints.”

There are three categories of joint motion:

1) Active exercise range of motion.

2) “Beyond the end of the active range of motion of any synovial joint, there is a small buffer zone of passive mobility.” A joint can only move into this zone with passive assistance, and going into this passive range of motion “constitutes mobilization.”

3) “At the end of the passive range of motion, an elastic barrier of resistance is encountered. This barrier has a spring-like end-feel.”

“If the separation of the articular surfaces is forced beyond this elastic barrier, the joint surfaces suddenly move apart with a cracking noise.”

“This additional separation can only be achieved after cracking the joint and has been labeled the paraphysiological range of motion.”

“This constitutes manipulation.”

“[Joint manipulation (adjusting)] requires precise positioning of the joint at the end of the passive range of motion and the proper degree of force to overcome joint coaptation [to overcome the resistance of the joint surfaces in contact].”

“With experience, the manipulator can be very specific in selecting the spinal level to be manipulated.”

The effectiveness of chiropractic care for spinal pain is well-documented. Chiropractic care (spinal manipulation) is routinely included in spine pain clinical practice guidelines (9, 10, 11, 12, 13). The effectiveness of chiropractic care for spine pain is beyond question.

•••••

In 2021, Sam Quinones authored a book titled (14):

The Least of Us

True Tales of America and Hope in the Time of Fentanyl and Meth

The primary theme of his book is the dangers of using methamphetamine (“meth”) made from the chemical phenyl-2 propanone as related to homelessness and to brain damage. He details how prior to 2006, meth was produced from an herb, ephedrine. Starting in 2006, ephedrine sales were largely banned through US government policy, forcing meth producers and sellers to come up with an alternative source. That source is the chemical phenyl-2 propanone.

The meth produced using the phenyl-2 propanone method is quite different than ephedrine meth; it is often referred to as “new” meth or “super” meth. In an article published in the magazine The Atlantic,

Quinones states (15):

“I Don’t Know That I Would Even Call It Meth Anymore.”

The major problem is that this “new” meth damages the brain, often irreversibly, and often in a short period of time.

Important to this discussion, Quinones integrates these three concepts (14):

• People can live and thrive without vision (blindness).
• People can live and thrive without hearing (deafness).
• But people cannot live and thrive without touch.

In his book, Quinones references the work of Johns Hopkins University neuroscientist David Linden, PhD, and his 2015 book, titled (16):

Touch

The Science of Hand, Heart, and Mind

In this book, Dr. Linden explains how touch is our most overlooked yet vital sense. He details how physical contact profoundly shapes our psychology, biology, and social behavior.

Dr. Linden explains the ways our nervous system processes touch experiences, including:

• Touch fires to the somatosensory cortex which maps discriminative details like location and intensity.
• Touch fires to the posterior insula which assigns emotional benefit and pleasure.
• Interpersonal touch is crucial for neurological development and acts as social “glue.”
• Touch reinforces cooperation, and even reduces stress.

In contrast, touch deprivation, especially in early development, can

lead to severe psychological and physiological consequences. Dr. Linden states (16):

“Touch is not optional for human development.”

“Doctors that touch their patients are rated as being more caring.”

There are four distinct types of touch receptors and they are all “mechanoreceptors because they have the common property of converting mechanical energy delivered to the skin into electrical signals” that travel to the brain.

Joint immobility will shrink the brain’s touch maps in as little as seven days.

Importantly, Dr. Linden notes that the fastest and most important touch receptors are “embedded in muscles, joints, and tendons” for an integrated sensation called “proprioception.” This observation has a particular importance to the chiropractic profession. Chiropractic care targets mechanical problems found in muscles, joints, and tendons. This would give chiropractic adjustments a profound influence on brain development and maintenance, including the ability of the brain to “actively and subconsciously suppress pain information on a moment-to-moment basis.”

Sir Issac Newton

Sir Isaac Newton (1643-1727) was an English polymath who was a

mathematician, physicist, astronomer, alchemist, theologian, author, and inventor. He was a key figure in the Scientific Revolution and the Enlightenment that followed. His 1687 book, Mathematical Principles of Natural Philosophy, was the first great unification of physics with established classical mechanics (17).

In Mathematical Principles of Natural Philosophy, Newton published his three laws of motion. These three laws remain the foundational principles in classical mechanics that describe the relationship between an object’s movement and the forces acting upon it. Newton’s three laws are:

The First Law (The Law of Inertia)

An object at rest stays at rest, and an object in motion stays in motion with the same speed and in the same direction, unless acted upon by an unbalanced (external) force.

The Second Law (The Law of Force and Acceleration)

The acceleration of an object depends directly on the net force acting upon it and inversely on its mass. It is famously expressed as the formula:

F = m × a

Where F is the net force, m is the mass of the object, and a is its acceleration.

The Third Law (The Law of Action and Reaction)

For every action, there is an equal and opposite reaction.

In the context of this publication, it is Newton’s Third Law that has the greatest relevance. Restated, Newton’s Third Law indicates:

When one object exerts a force on a second object, the second object instantly exerts an equal and opposite force back on the first.

This concept of “an equal and opposite reaction” is universally accepted, and it applies to the concept of touch. When a chiropractor touches a patient, the patient is touching the chiropractor. Frankly stated, being a chiropractor is an awesome occupation:

• Chiropractors assess a patient’s mechanical function through the use of touch (through palpation and range of motion).
• Chiropractors improve a patient’s mechanical function through the use of touch (delivering adjustments/manipulation, and tissue work).
• And the chiropractor themselves are benefited by the patient touching them in return.

Chiropractic Diagnostics

An essential and important diagnostic tool that chiropractors use is palpation. Palpation is defined as a physical examination procedure where a healthcare provider (chiropractor) uses their hands or fingers to touch and feel their patient’s body. It is used to assess ranges of motion, symmetry of motion, joint end-play, aberrant movement parameters, tissue texture, alignment, tenderness, swelling, spasm, hypertonicity, temperature variations, and/or pain, etc.

Chiropractors typically use both static palpation and motion palpation when assessing a patient’s mechanical function. As such, chiropractic diagnostic testing extensively uses touch.

Chiropractic Care

Chiropractic care is mechanical-based care that primarily uses the chiropractic adjustment (specific line-of-drive manipulation). Chiropractic education, licensure, and experience allows the chiropractor to determine the precise location and direction for the applied adjustment. All of these determinations and applications also extensively involve the use of touch.

The 2021 Nobel Prize in Physiology or Medicine

In his book, Dr. Linden discusses the work of David Julius, PhD, and Ardem Patapoutian, PhD. Drs. Julius and Patapoutain detail the importance of mechanical influences on human physiology and health. Specifically, they detail the physiological influences of articular position and motion. Their work was awarded the Nobel Prize in medicine or physiology in 2021 (18, 19).

Dr. Julius is a professor and chairman of the department of physiology at the University of California, San Francisco. Dr. Patapoutian is a professor at Scripps Research in La Jolla, California. Their Nobel Prize included explaining the molecular basis for sensing mechanical forces, including how the body senses position and movement.

As noted by Dr. Linden and quoted above, the modality of touch uses mechanoreceptors, the same mechanoreceptors that are a component of Drs. Julius’ and Patapoutain’s 2021 Nobel Prize. Chiropractic adjustments make extensive use of these mechanoreceptors (20). These mechanoreceptors have been identified in human intervertebral discs (21, 22, 23), in human facet joint capsules (24, 25), and in the paraspinal ligaments (26).

An in-depth integration of all of these mechanical influences is found in the 2017 book Move Your DNA: Restore Your Health Through Natural Movement, written by biomechanist Katy Bowman (27). Ms. Bowman integrates the importance of mechanoreceptors, gravity, alignment, posture, and motion, noting that “our bodies respond to mechanical input.” All of these factors are a component of chiropractic clinical care, and they are all influenced by the use of touch.

•••

Dr. Richard’s story (continued…)

Mr. Smith’s improvements were undeniable. Yet he continued to show up at Dr. Richard’s office for treatment much more frequently than Dr. Richard had recommended. And as from the beginning, Mr. Smith was always early and dressed impeccably.

Dr. Richard had an extended talk with Mr. Smith. He calmly explained to him that he no longer needed to come in so often for care. Yet, he observed disappointment and concern on Mr. Smith’s face. Shortly after, Dr. Richard read Mr. Smith’s obituary. Mr. Smith had died by suicide.

Dr. Richard’s retrospective assessment of the events involving Mr. Smith include:

With his retirement, the death of his wife, with his children and grandchildren not being geographically close, and living on his own, his relationship with Dr. Richard became increasingly important. Dr. Richard would listen to him, examine him, mechanically treat him, give him home-care advice, and follow-up on his progress and activities. Importantly, examination and mechanical care (chiropractic adjustments) in particular, involve touch.

Often, elderly and alone patients are isolated away from touch. Touch is an intimate component of chiropractic care. For many of these elderly, chiropractic care, with its inherent touch, can be a very important addition to their day, week, month, and life.

Summary

Chiropractors touch people. Touch is an integral component of chiropractic manual diagnostics (palpation, range of motion, etc.) and of the adjustment itself (the key component of chiropractic mechanically-based care).

Chiropractors tend to view the value of their patient care in three areas:

• Chiropractic care, by its very nature, involves touch. Touch, in and of itself, is a valuable modality for all people.
• Chiropractic touch is designed specifically to improve mechanical integrity. Improvements in mechanical integrity have many physiological benefits for patients, including improved motion, dispersion of inflammatory pain producing exudates (chemicals), reducing nerve irritations, and neurologically activating the supra-segmental descending inhibitory control system.
• Newton’s Law of “equal and opposite reaction” means that when chiropractors use touch during patient care, the chiropractor equally benefits.

Few outside of the chiropractic profession understand the personal

satisfaction there is in being a chiropractor.

REFERENCES:

1. Pert C; Molecules of Emotion: The Science Behind Mind-Body Medicine; 1997.
2. Anderson R; “Spinal Manipulation Before Chiropractic”; in Haldeman S; Principles and Practice of Chiropractic; Second Edition; Appleton & Lang; 1992.
3. Pettman E; A History of Manipulative Therapy; The Journal of Manual & Manipulative Therapy; 2007; Vol. 15; No. 3; pp. 165–174.
4. Adams J, Peng W, Cramer H, Sundberg T, Moore C; The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults; Results From the 2012 National Health Interview Survey; Spine; December 1, 2017; Vol. 42; No. 23; pp. 1810–1816.
5. Haldeman S; Modern Developments in the Principles and Practice of Chiropractic; Appleton-Century-Crofts; New York; 1980.
6. Kirkaldy-Willis WH; Managing Low Back Pain; Churchill Livingston; 1983 and 1988.
7. Kirkaldy-Willis WH, Cassidy D; Spinal Manipulation in the Treatment of Low-Back Pain; Canadian Family Physician; March 1985; Vol. 31; pp. 535-40.
8. Fischgrund JS; Neck Pain; Monograph 27; American Academy of Orthopaedic Surgeons; 2004.
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14. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians; For the Clinical Guidelines Committee of the American College of Physicians; Annals of Internal Medicine; April 4, 2017; Vol. 166; No. 7; pp. 514-530.
15. Quinones S; The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth; Bloomsbury Publishing; 2021.
16. Quinones S; “I Don’t Know That I Would Even Call It Meth Anymore”; The Atlantic; November 2021.
17. Linden D; Touch: The Science of Hand, Heart, and Mind; Penguin Books; 2015.
18. Newton I; Mathematical Principles of Natural Philosophy; July 5, 1697.
19. Roland D, Abott B; Nobel Prize in Medicine Awarded for Work on Senses; Wall Street Journal; October 5, 2021.
20. Zylka MJ; A Nobel Prize for Sensational Research; New England Journal of Medicine; December 16, 2021; Vol. 385; No. 25; pp. 2393-2394.
21. Kirkaldy-Willis WH, Cassidy JD; Spinal Manipulation in the Treatment of Low-Back Pain; Canadian Family Physician; March 1985; Vol. 31; pp. 535-40.
22. Mendel T, Wink CS, Zimny ML; Neural Elements in Human Cervical Intervertebral Discs; Spine; February 1992; Vol. 17; No. 2; pp. 132-135.
23. Roberts S, Eisenstein SM, Menage J, Evans EH, Ashton IK; Mechanoreceptors in intervertebral discs: Morphology, distribution, and neuropeptides; Spine; December 15, 1995; Vol. 20; No. 24; pp. 2645-2651.
24. Dimitroulias A, Tsonidis C, Natsis K, Venizelos I, Djau SN, Tsitsopoulos P; An immunohistochemical study of mechanoreceptors in lumbar spine intervertebral discs; Journal of Clinical Neuroscience; June 2010; Vol. 17; No 6; pp. 742-745.
25. McLain RF; Mechanoreceptor endings in human cervical facet joints; Spine; March 1, 1994; Vol. 19; No. 5; pp. 495-501.
26. McLain RE, Pickar JG; Mechanoreceptor endings in human thoracic and lumbar facet joints; Spine; January 15, 1998; Vol. 23; No. 2; pp. 168-173.
27. Panjabi MM; A hypothesis of chronic back pain: Ligament subfailure injuries lead to muscle control dysfunction; European Spine Journal; May 2006; Vol. 15; No. 5; pp. 668-676.
28. Bowman K; Move Your DNA: Restore Your Health Through Natural Movement; Second Edition; Propriometrics Press; 2017.

“Authored by Dan Murphy, D.C. Published by ChiroTrust® – This publication is not meant to offer treatment advice or protocols. Cited material is not necessarily the opinion of the author or publisher.”