Tonight I will be heading up to Birmingham to talk at the BCA Chiro Live 2023 conference.
I will be talking about the idea of Integrative Chiropractic, the art of integrating the very best new science and practical insights into our existing clinical model.
And that is a very important point, integrating into our existing model, not instead of.
I see a very worrying trend in both the Chiropractic and Osteopathic professions.
A slow eradication of the basics of what we do, via non-clinican academics at the teaching institutes.
We care for and restore function of the neuro-mechanical system.
It is the foundation of what we do.
How you did really does not matter, the important thing is to have integrity and authenticity and measure something meaningful.
Do this multiple times in the treatment session, and then re-assess at the start of the next session, are your results sustainable?
If the ROM increases significantly and the pain levels remain, consider if the patient’s peripheral and central nervous system is HYPER-SENSITIVE.
And that would lead us to the question of why would be HYPER-sensitive to incoming input?
One cause is a sustained low grade inflammatory response.
Key word in that, sustained, meaning on-going.
It is not a mistake, the immune system has targeted a perceived threat, and is responding to it accordingly.
It is a response due to something or against something.
But here it gets even more interesting.
In the world of the bio-psycho-social model, they seem to focus more on association, not causation.
And in fact, as this paper from Hancock says.
The answer is it was the old bio-medical model, stuck to the Gordon Waddell inspired pyscho-social model.
If you can’t see a thing on x-ray or MRI that is definitively the cause, then there is no physical cause of pain.
In reality, you can’t see everything on MRI, annular tears for example, are commonly a source of pain with normal MRI findings.
Another misunderstanding is that if some people with pathology have no symptoms, then people with symptoms and pathology it cannot be the cause of pain.
Can you imagine a cardiologist telling a patient with crushing left chest pain and narrowing of their arteries “some people with those findings have no chest pain, so it is normal for your age and any pain in your chest is actually all in your head”?.
OK, so maybe that feels too far?
Well, how many patients have you sent off to have a hip replacement without significant degenerative changes?
I would guess none.
Do you have some patients with a lot of significant degenerative changes with no symptoms?
Of course you do, but this is patient-centred care, which is personalised, isn’t it?
Isn’t that a central tenent of evidence-based medicine?
Or are we now teaching our students to practice average, statistical medicine?
My pitch to the BCA is that we must maintain our identity and our core therapeutic model of functional restoration AND integrate the low-hanging clinical fruits of the nutrition/functional medicine world.
Neuro-inflammation is as hot a topic as you can get.
Neuro-inflammation is a known cause of mental illness/depression/anxiety.
We can induce it in labs with a simple injection of bacterial toxins.
Inflammation kicks in within an hour and note as does cortisol (inflammation is stressful).
And anxiety goes up, mood goes down.
And neuro-inflammation is a known cause of peripheral and central hypersensitivity.
And we can reduce pain thresholds in an hour after a bacterial injection.
Thus we can say that neuro-inflammation “primes” a subgroup of patients with chronic pain and mental illness.
It is a unifying root cause of both.
Yes, psycho-social factors play a role, and we need to be aware, but when you have neuro-inflammation your resilience is low and small amounts of stress knock you down.
And did you know that one of the mechanisms for stress causing mental health issues is via inflammation?
Patients with adverse childhood events have a higher baseline of inflammatory cytokines than controls and when given a social stress test their “primed” immune system then kicks off far more than controls.
I believe that our future is also our past.
Maintain what works, functional restoration of the neuro-mechanical system:
– get obsessed with being a master manipulator
– with being awesome at releasing fascia
– unteathering nerves as they pass through soft tissues and more.
But recognise that chronic problems by definition are complex and multifactoral, both the pain generator and the causes.
Silver bullets are for werewolves, not chronic patients.
Ask yourself every time:
You do not have to resolve every little thing, you just need to break the vicious cycle.
And join us as integrative neuro-mechanical practitioners in 2024 when we open up enrollment for our flagship course, Core Concepts in Chiropractic Nutrition (CCCN) in January 2024.
Remember, we are running a free Collagen webinar on Wednesday next week, 22nd at 7.30, join us as we bust some collagen myths and dish out some glycine based magic, for 1 hour free CPD.