One failure of chiropractors

One specific failure of the chiropractic profession   

**Note to chiropractors: In keeping with the study referenced below, in this article I will refer to the body of the vertebra when discussing vertebral segment rotation, not to the spinous process like we were taught in school.**

A chiropractor is a specialist in the treatment of spinal dysfunction. If the joints within your spine are not moving correctly, a chiropractor should be the expert of choice. The spine is the main focus of his study.

Yet, strangely, there is a fundamental mistake being made by most chiropractors when they treat the neck for vertebral motion dysfunction.

According to this published review, https://www.ncbi.nlm.nih.gov/pubmed/16949947, the cervical spine normally moves in what’s called a coupled way. This means that not only do cervical vertebrae tilt in the direction of head tilt, but they rotate simultaneously. But they don’t rotate randomly, they rotate in a very specific direction.

For example, when you tilt your head to the right, the vertebrae also rotate to the right at the same time. When tilting left, they rotate left. They never rotate away from the side of tilt. You could say they always go the same direction. This is called “coupled motion” since the two motions always occur together.

But for those of you who have been to a chiropractor before, you might remember how he “popped” your neck. As you are lying on your back, facing up, the chiropractor takes your head and neck, he puts your right ear toward your right shoulder, and then he rotates your head to the left as he “pops” it. Remember? Close your eyes and picture what position your head is in when he treats your neck. Head toward the shoulder and then the chin toward the opposite shoulder. Yes? Hmm.

Those having received lots of neck treatments might learn that the treatment relieves pain but often only for a short time. So some patients learn how to “pop” their own necks (not advisable). What do they do? They mimic what the chiropractor did: tilt the ear toward the shoulder and twist the chin to the opposite side. If you don’t do this (which you shouldn’t), you may have seen other people doing it, using a hand on the chin to twist the neck into that unnatural position until it pops.

But the neck naturally rotates to the same side, not the opposite, as mentioned in the above paper. So the chiropractor essentially treats the neck in a way that is completely opposite to normal motion. This has been called “uncoupled motion,” because it’s inducing an unnatural pairing of motions.

Okay, fine, it’s backwards, who cares? Well, sadly, there aren’t enough good studies to know for sure much of anything about “alternative” treatments like chiropractic. So we’ll have to look at it from a philosophical and a clinical perspective.

During a chiropractic treatment of the neck, there are at least two things going on. One is the cavitation of the joint, this is what makes the “pop” sound. Another is the resetting of the tone of the muscles surrounding the joint, this is what makes the neck tension go away. Both have benefits to the patient.

Chiropractors could argue that the popping of the joint using an uncoupled versus coupled motion makes little difference to the joint itself, and they might have a point. But it’s harder to argue for this when discussing the resetting of the muscles around the joint because this “resetting” is accomplished through neurological pathways from the joint and muscle stretch receptors firing into the spinal cord and up to the brain.

These neurological signals from the treatment stimulate spinal cord reflexes, and brain relay centers, all of which help regulate the tone and sensitivity of the neck muscles. In this way, the chiropractic treatment of the neck could be said to be “teaching” the muscles something, usually to be more relaxed, if not more responsive to head motion (hopefully in a good way).

If one goal of the treatment is “teaching” the neck muscles how to move normally again, then why would the chiropractor “pop” your neck by using uncoupled motion? You are right, it makes no sense. It would make more sense to treat the neck using coupled motion.

Clinically I have noticed that those patients with the worst neck dysfunction, in general, tend to be the ones who have had the most chiropractic treatments to their necks in the past. This could be a coincidence, perhaps those with bad necks go to the chiropractor the most because they need it the most?

I think that the uncoupled chiropractic treatment can be somewhat helpful to the joints of the neck in the short run, but over time these uncoupled motion treatments begin to confuse the nervous system causing long term joint dysfunction. In other words, the joints aren’t tracking correctly, over time causing joint inflammation and perhaps degeneration. To be fair, it may have been a physical injury, like a car accident, that caused the abnormal neck motion in the first place, and perhaps the chiropractic uncoupled motion treatment didn’t cause it. But it seems to at least have not fixed the motion either.

I do see plenty of patients who have never seen a chiropractor before, and many of them also have poor neck motion (almost always having a clear history of neck trauma). But they tend to need fewer coupled neck treatments to correct the issue than those patients with a long history of chiropractic uncoupled neck treatments. Like a lot less.

The sad state of affairs is that to the best of my knowledge, every chiropractic college teaches only the uncoupled neck treatments. Of course they don’t call them that, nor do they acknowledge such a thing exists. And certainly there isn’t tons of scientific knowledge on this topic, but there isn’t a ton of it on most everything else chiropractic does either. A lack of scientific studies has never stopped the colleges from theorizing before.

There used to be a post-graduate program that taught chiropractors how to perform coupled neck treatments. The post-grad teachers asked some of the undergrad chiropractic colleges to allow them to teach this better method to the undergrad students, but the colleges refused, essentially saying that there was nothing wrong with the old way of doing it.

From what I’ve heard, this post-grad school has now stopped teaching the correct coupled motion neck treatments even to post-grad students. Unfortunately, for a chiropractor to change his neck treatments from uncoupled to coupled, it’s not as simple as just reading this article. It’s like learning how to ride a bike. You can’t learn it by reading about it, you have to fail at it over and over until you get it right. Most established chiropractors don’t want to go through the effort, and even if they did, they need a teacher to help them just like they did when they first learned the traditional uncoupled treatments at school.

There are perhaps some ways around this. The chiropractor could use a mechanical device like an “activator,” making sure to position the head in lateral flexion together with chin rotation to the same side when using it, or keeping the head in neutral. He could employ any of the hundreds of “non-force” chiropractic treatments. Or he could stick to any neck treatments he already knows how to do where the head is in a neutral position. But bad habits die hard.

I have been fortunate enough to have learned coupled motion neck treatments from one of the best. Unfortunately he is a dying breed, and he doesn’t teach anymore. The results I have observed from using coupled neck treatments compared to the traditional uncoupled treatments are profound.

The human neck is unique among all animal necks on the planet. It allows us to walk upright, and some might argue that the specialized human neck allows us to have a human brain in the first place. When the neck segments move correctly, our standing posture improves effortlessly, and all the other joints of the body are allowed to align and move properly too. Clinically, I see improved posture and walking motion immediately after resetting patients’ necks with coupled motion treatments. I see this every day at my clinic. I never saw this when I was using uncoupled treatments at the chiropractic college.

At best, I would say that an uncoupled neck treatment takes pain out of the neck for a time. At worst, it creates never ending spinal dysfunction, or at least perpetuates the dysfunction that was already there. By contrast, a coupled neck treatment at worst relieves neck pain, and at best allows us to be more fully human.