As I mentioned in a previous newsletter/blog, I’ll be writing more this year about chiropractic and healthcare after twenty years in the profession.
Remember: Chiropractic is a healthcare profession. It is not synonymous with spinal manipulation – a manual therapy technique with scientific evidence of providing pain relief for spine-related pain. Try not to view the role of a chiropractor as the spinal manipulation provider but as a healthcare provider with expertise in musculoskeletal care, including diagnostic, treatment, and preventative care.
Twenty-four years ago
More than two decades ago, I entered chiropractic college here in Toronto at CMCC. Four years later, twenty years ago, I took my Doctor of Chiropractic diploma into the real world. Looking back, I realize how unprepared I was for this real world. I also didn’t realize how the chiropractic landscape would change during my career.
Don’t get me wrong, CMCC did an excellent job teaching me core science (eg. biochemistry, physiology), and the fundamentals of chiropractic (i.e. spinal manipulation, orthopedic & neurological diagnostics). My classmates and I were even exposed to the current controversies within the profession. I recall distinctly the day we debated whether ‘NetworkSpinal’ should even be considered chiropractic. Had I not been exposed to ‘network’ prior to my chiropractic education, I would have had no idea what we were even talking about. Before entering CMCC, I observed various chiropractors to ensure this was the profession for me. One such chiropractor was transitioning from a ‘straight’ chiropractor (i.e. spinal manipulation, biomechanics) to ‘network’. He was actively changing his practice style from the traditional style of chiropractic care to a radically different style that, debatably, is not chiropractic – it was more of an ‘energy-transfer’ technique that could be practiced by anyone in healthcare, but disproportionately popular among chiropractors looking for an alternative approach. Thus, the debate in school was whether the OHIP funded (at the time) chiropractic care should pay for this ‘technique’. My classmates and I were divided on the issue. I recall the majority, me included, felt that only the ‘straight’ chiropractic approach should be considered chiropractic, and thus covered by chiropractic insurance. The minority was passionate that the technique should not matter if the provider was a licensed chiropractor.
Twenty Years Later
I look back on this debate now with a new perspective. Firstly, rightly or wrongly, chiropractic care is no longer funded by OHIP. Musculoskeletal issues continue to affect people’s quality of life and represent a major burden to our healthcare system, yet we don’t prioritize care or prevention. Secondly, since graduation, I have dabbled in various ‘techniques’, searching for the secret recipe to effective, efficient patient care. The various continuing education courses I took searching for said recipe all left me wanting more. Sure, I learned some alternative spinal manipulation and diagnostic techniques, but they all seemed more focused on the doctor’s time efficiency and cultivating a patient base that would be reliant on their chiropractic appointments (almost entirely spinal manipulation). There were (still are) many chiropractic conferences designed to train the chiropractor how to grow their practice by establishing excessive treatment plans, payment plans, and reliance on x-rays. It is hard to remember if I knew this approach to patient care was wrong, or if I just didn’t have the personality (‘chutzpah’ for those of you who speak Yiddish), to pull it off. I certainly believe now that it’s not good patient care, and I don’t have the chutzpah for it.
I have a different perspective now than I did as a student and newbie chiropractor. I was wrong in the mindset that every pain, spine-related or not, was the result of faulty biomechanics. We know now this to be false. We have learned beyond a shadow of a doubt that pain is multifactorial, and this has ushered in the ‘biopsychosocial’ era of patient care. Don’t get me wrong, faulty biomechanics (eg. stiff joints, poor flexibility, weakness, sprained/strained soft tissue) remain a significant cause of physical pain. But poor sleep, stress, fitness levels, job satisfaction, relationships, and connectedness are also players in the pain game – I believe these variables represent the volume knobs on pain from those biomechanical issues. The biopsychosocial approach to patient care essentially teaches us to respect all potential sources of pain, rather than narrowly focusing on the one element that we’re good at managing.
So, looking at an old debate through a new lens, I arrive at a nuanced new opinion. If pain relief is the goal, then it doesn’t matter what technique one uses for a remedy. Pain medication, massage, manual therapy, acupuncture, laser, exercise, meditation, deep breathing, etc., are all valid. So, should a chiropractor be able to bill insurance for chiropractic care even if the technique being wielded is vastly different from the classical approach? Sure!
But…
Yes, of course, there’s a ‘but’. And the ‘but’ is my main point: Pain Relief should not be the only goal. Certainly, pain relief is needed, especially on a journey to resolve whatever is the cause of said pain, but there is so much more to the care of the human body than just chasing away pain. So, you’ll often find me asking you what your goal is. Often, the answer is pain relief. But, beyond the pain conversation, we uncover so many other goals: Health, wellness, longevity; improved joint health; strength and balance; and confidence to live alone, especially when older. As you can see, some of the pain relief options may work for the goal of pain relief but don’t provide any value to these other goals.
Goals
Be honest about your goals. And don’t let me project my values onto you. But I encourage you to not think too short-sighted about your health and wellness goals. Pain today sucks. But, long term, I wish you to have strength and mobility, cardio-respiratory fitness, good mental health, a long life full of connectedness, and the ability to do what you want when you want it.
I’ll share more about exercise, chiropractic care, nutrition, self-care, and more as it relates to pain relief and long-term health strategizing in the blogs to come throughout the year.
Whether you are seeking pain relief, exercise advice, injury management, or you just need your Leafs talk or Bachelor chat, I’m available.