Everybody paddle the canoes together!
By Sharon A. Vallone, DC, FICCP
Editor, Journal of Clinical Chiropractic
Pediatrics
Twice a year, it’s a frantic rush to reel in the
fishing lines cast out across various continents
so another issue of the JCCP can be published
with contributions from individuals who step out
of their comfort zone, their daily workload, to
author a manuscript that will hopefully offer
some clinical insight, some cumulative data,
some educational nugget to help each of us in
our daily chiropractic practice, as an author,
teacher, mentor or perhaps another healthcare
provider or parent who is searching for the
missing piece for their patient or client or
their own family.
Chiropractic has been in the eye of the storm
since its inception. Recently, I was honored to
participate in an international forum to attempt
to codify current practice guidelines for
pediatric chiropractors to once more, attempt to
represent what we do with accountability,
clinical insight and experience combined with
what research is available. It was a positive
experience with contributions that were
constructive and respectful until the final
product was sculpted and set out to dry (and we
still write to each other as we see things that
could be tweaked, added, perhaps said more
concisely… as practice, and life, are meant to
be fluid!).
In comparison, though, part of what we’ve all
realized is that more time and effort, let alone
all the research money, is being spent producing
literature criticizing our “lack of evidence”
rather than our “wealth of positive clinical
outcomes”. And limiting all the meagre research
funding to only one possible positive outcome of
chiropractic (low back pain) leaves us without
the opportunity to explore the “unproven”
results obtained when applied appropriately in a
myriad of different clinical scenarios.
Challenges to the profession and its scope of
practice, spurred the formation of an
international group spearheaded by two
chiropractors in Australia whose colleagues have
been under political scrutiny. In an ongoing
email discussion between participants, my
co-editor Dr. Cheryl Hawk (Texas Chiropractic
College) and one of the founding members of the
group, Dr. Lyndon Amorin-Woods (Murdoch
University Chiropractic Clinic), shared these
thoughts:
Dr. Hawk
“I keep thinking of a comment a colleague
(psychologist, Bob Jensen) made years ago, that
the purpose of research is to IMPROVE practice,
not PROVE it. Chiropractic has had to spend so
much time and money trying to PROVE that its
practice is legitimate (which we’ve only done
thoroughly for LBP, because the medical
profession is able to understand “work on back =
might help back pain”) that we have very little
left over to do research to IMPROVE practice.
And the political opponents are twisting the
research (that is, basing it on the “lack of
research” equals “lack of effectiveness”
fallacy)1-3 to disprove it.”
As Marson Smith stated: “Systematic reviews of
healthcare interventions need to be as clear as
the evidence will support. Many people will read
only the abstracts of systematic reviews.
Leaving readers with the impression that there
is no difference between alternative treatments
may result in dangerously misinformed clinical
decisions and failure to address important
uncertainties in additional research.”2
Dr. Amorin Woods
The point is this.
It is meaningless to consider just the
evidence of the ‘intervention’ without that
for the options or alternatives. 95% of healthcare is lacking evidence, spinal
manipulative therapy (SMT) is no worse (or
better) than most other medical or other
interventions for most childhood conditions.
That is why, recognizing that the clinician is
(virtually) always working within a context of
clinical uncertainty, that the principle is to
be ‘defendable’ rather than ‘right’ or
definitive.
Of course, one must always strive to be
‘correct’ but must also recognize the
limitations inherent in ‘diagnosis’ or ‘clinical
labelling’.”
Always ahead of her time, Dr. Hawk wrote a paper
in 1998 while at the Palmer Center for
Chiropractic research clearly stating that we
are a profession not a procedure.
“…its application (the chiropractic adjustment)
must be informed by a unique approach to healing
and health that is distinct from, although not
necessarily at odds with, the medical model. For
it is the philosophy, the intuitive knowledge -
the belief system - that differentiates a
complete system from a procedure.”
So, here we are. Some of us, clinicians in the
field, some researchers in the “lab” and some
individuals in other professions who see that
collaborative efforts reap the best outcome. The
JCCP will continue to not only bring both
clinical and research outcomes to our readers
but to encourage us to maintain our course and
provide the best chiropractic care we are able
to our vulnerable population. Vulnerable because
they are young and growing in both body and
mind. Our example, our words and our
chiropractic care are part of their formative
process.
This year, the harvest is in (this was a winter
crop! And if I wasn’t mixing metaphors, it would
be the catch or the haul, I guess) and being
sorted and polished for presentation during the
powerful lunar eclipse. Eclipses are known to be
“harbingers of change”. Look around you, are
your patients more stressed and needing your
ministrations than you’ve ever experienced your
practice lifetime? Then look at yourself; how
are you faring in these times of un-rest and in
some cases, un-safety? Whether it’s your
personal safety in your environment, your safety
in choosing your own health care or protecting
your privacy, or professionally, legislative
changes to your license and scope of practice,
information distribution, or even insurance
reimbursement?
To be present therapeutically for your patients
(many too little to use their worlds to explain
their stress level but manifesting it through
their body or behaviors instead!) you need to
begin with self-care including rest, nutrition
and movement (Movement through: Exercise!
Breathing! Dancing! Skipping!).
Then, you need to keep learning - talking to
each other, reading, attending courses (perhaps
we’d consider the greater availability of online
education a benefit of this past 3 years?).
Restoring your mind and body and building some
more plastic connections neurologically are the
first order of self-care that can then be
extended to our patients not only with what we
can contribute but motivating and empowering
them to put their own self-care strategies in
place because they too (parents) need to take
care of themselves so they can take care of the
children, but also, we’re never too young to
learn self-care routines and we have the
opportunity to educate the youngest amongst us
every time they enter our office with the joy
they bring to you at each visit.
The entire world is scrambling to come out of
crisis mode and the time is on us to look at
transformation rather than continuing to slog
through the same mud every day. There are great
movers and doers amongst us, and I salute them!
Our leaders inspire us and often point us in the
most effective direction we can walk. And for
many of us, our world is our office and our
patients and the ripple effect of what we do for
each individual cannot be underestimated, ever,
because they too will reach out and touch
another and another and another and THAT is how
we get the job done!
“E lauhoe mai na wa`a; i ke ka, i ka hoe; i
ka hoe, i ke ka; pae aku i ka ‘aina.”
Everybody paddle the canoes together; bail
and paddle, paddle and bail, and the shore
will be reached.
References:
1. Goertz C, Hurwitz E, Murphy B, Coulter I.
Extrapolating Beyond the Data in a Systematic
Review of Spinal Manipulation for
Non-Musculoskeletal Disorders: A Fall from the
Summit. J Manip Physiol Ther. 2021.
2. Marson Smith PR WL, Adams C, Chalmers I,.
Claims of ‘no difference’ or ‘no effect’ in
Cochrane and other systematic reviews.
BMJ Evidence-Based Med. 2019.
3. Hawk C. Comment on Goertz et al article.
J Manipulative Physiol Ther. 2021;44(6):506-507.
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