DPhCS Thank you to the LKR for having me Chiropractic today I hate grapefruit Chiropractic Philosophy and Pizza The challenge of speaking on chiropractic philosophy What is horology The goals of this presentation ID: 914042
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Slide1
LKR
Eric G. Russell, DC,
DPhCS
Slide2Thank you to the LKR for having me
Slide3Chiropractic today
Slide4I hate grapefruit
Slide5Chiropractic Philosophy and Pizza
Slide6The challenge of speaking on chiropractic philosophy
What is horology?
Slide7The goals of this presentation
My goals for my presentation today
Use this presentation as a starting point.
Test a hypothesis
on a group I
respect.
Look at chiropractic through an evolutionary/anthropology/qualitative
lens.
Apply chiropractic principles today’s
health issues.
START A DISCOURSE!!!!!
Slide8The outline of this presentation
Slide9N=1
Slide10Human kind and the two environments
10
Slide11The Emergence of Evolutionary Biology
The hypothesis that there is
purpose
in the body’s design, including its responses to environmental challenge
Symptoms such as fever, loss of appetite, fatigue, vomiting, and diarrhea are adaptive responses, and as such, enhance survival value
Slide12Optimal foraging strategy
Chances
are, when observing animals in the wild, you are most likely to see them foraging for food. If successful, their foraging efforts culminate in feeding. Animals search, sense, detect and feed. For humans, feeding is often associated with pleasure.
Sinervo
, B. (1997). Optimal foraging theory: Constraints and cognitive processes.
University of Southern California Santa Cruz: available at
printfu
. org/foraging+ animals
, 105-130
.
Although obtaining food provides the animal with energy, searching for and capturing the food require both energy and time. The animal wants to gain the most benefit (energy) for the lowest cost during
foraging
, so that it can maximize its fitness
Slide13Frank Booth, PhD
“
Our lifespan should not outlast our
healthspan.”Zamzow
, R. (2016, February 02). One hundred years young: Frank Booth's vision for a healthier America. Retrieved February 02, 2018, from https://
unearthedmag.wordpress.com
/2015/04/19/one-hundred-years-young-frank-booths-vision-for-a-healthier-america/
Slide14Exercise and gene expression
In this sense, our current genome is maladapted, resulting in abnormal gene expression, which in turn frequently manifests itself as clinically overt
disease
…
We
also contend that the current scientific evidence supports the notion that disruptions in cellular homeostasis are diminished in magnitude in physically active individuals compared with
sedentary individuals”
Booth, F. W.,
Chakravarthy
, M. V., &
Spangenburg
, E. E. (2002). Exercise and gene expression: physiological regulation of the human genome through physical activity.
The Journal of Physiology
,
543
(
Pt
2), 399–411. http://
doi.org
/10.1113/jphysiol.2002.019265
Slide15Sedentary lifestyle
Physical inactivity accompanies diet and tobacco use as
a
leading
risk factor
for premature death and poor health. In total, 35 conditions, including diabetes and respiratory problems, are caused or amplified by inactivity, Booth said. And in the early 2000s he coined a term for this set of risks: “sedentary death syndrome.
”
The State of US Health, 1990-
2010 Burden
of Diseases, Injuries, and Risk Factors.
JAMA.
2013;310(6):591–606. doi:10.1001/jama.2013.13805
Slide16Healthcare today
16
More than
70%
of adults across the United States are already being diagnosed with a chronic disease and more than
75%
of the nation’s healthcare cost being spent on managing and treating these
conditions.
Shocking American Health Statistics. (2014, February 6). Retrieved October 13, 2016, from http://www.healthfitnessrevolution.com/shocking-american-health-statistics/
Slide17Chronic illness is on the rise
The rate of chronic illnesses in the United States is on the rise.
Buttorff
, et al, (2017) from the RAND corporation note, “150 million Americans are living with at least one chronic condition; around 100 million of them have more than one. And nearly 30 million are living, day in and day out, with five chronic conditions or more.
Buttorff
, C, Teague R, and Melissa B, Multiple Chronic Conditions in the United States, Santa Monica, Calif.: RAND Corporation, TL-221-PFCD, 2017. As of November 01, 2017:
https://www.rand.org/pubs/tools/TL221.html
Slide18Chronic illness is on the rise
Those at the highest end of the scale, with five or more conditions, represent about 12 percent of the U.S. adult population, but account for more than 40 percent of U.S. health spending. That could translate into more than $1 trillion a year, based on current estimates of overall health care costs”.
Buttorff
, C, Teague R, and Melissa B, Multiple Chronic Conditions in the United States, Santa Monica, Calif.: RAND Corporation, TL-221-PFCD, 2017. As of November 01, 2017:
https://www.rand.org/pubs/tools/TL221.html
Slide19Chronic illness in Sweden
Methods: two
nationally representative surveys of the elderly population (
n = 537 and 563, respectively), including both community-based and institutionalized persons were used. Outcomes include self-reported diseases, symptoms, and activities of daily living, as well as objective tests of physical capacity, lung function, vision, and cognition.
Parker, M. G.,
Ahacic
, K., &
Thorslund
, M. (2005). Health changes among Swedish oldest old: prevalence rates from 1992 and 2002 show increasing health problems.
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
,
60
(10), 1351-1355.
Slide20Chronic pain in Sweden
CONCLUSION:
Chronic musculoskeletal pain is common in the general population.
Sociodemographic variables were overall more frequently and strongly associated with CWP
(chronic widespread pain) than
with
CRP (chronic regional pain),
which indicates different pathophysiology in the development or preservation of pain in the 2 groups
.
Bergman
, S.,
Herrström
, P.,
Högström
, K. R. I. S. T. I. N. A.,
Petersson
, I. F.,
Svensson
, B., &
Jacobsson
, L. T. (2001). Chronic musculoskeletal pain, prevalence rates, and
sociodemographic
associations in a Swedish population study.
The Journal of rheumatology
,
28
(6), 1369-1377.
Slide21Chronic Illnesses in Sweden
Results
.
None of the indicators showed improvement. A number of health indicators showed significant worsening, with or without adjustment for changes in the age and sex distribution from 1992 to 2002
. Among self-reported indicators, there were significant increases in several diseases and symptoms. The objective function tests also showed significantly worse results in 2002 compared to 1992 for physical capacity, lung function, and cognition. No significant differences in activities of daily living limitations were found
.
Parker, M. G.,
Ahacic
, K., &
Thorslund
, M. (2005). Health changes among Swedish oldest old: prevalence rates from 1992 and 2002 show increasing health problems.
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
,
60
(10), 1351-1355
.
Slide22Standard American Diet
22
Why We Are Getting Fat (Part 2) - Chris Ruden. (n.d.). Retrieved October 13, 2016, from http://chrisruden.com/blog/weight-loss/getting-fat-part-2/
Slide23Healthcare today
23
Slide24Childhood obesity rates in Sweden are better!
In Stockholm, obesity prevalence during academic years starting 1999 and 2003 decreased non-significantly from 4.4% to 2.8% in girls, and increased non-significantly from 3.2% to 3.8% among boys. In Gothenburg, comparing academic years starting 2000 and 2004, prevalence of overweight in girls decreased from 19.6% to 15.9% (
P
< 0.01) while thinness increased from 9.5% to 11.9% (
P
< 0.05); no significant changes were observed in boys.
Lissner
, L.,
Sohlström
, A.,
Sundblom
, E., &
Sjöberg
, A. (2010). Trends in overweight and obesity in Swedish schoolchildren 1999–2005: has the epidemic reached a plateau?.
Obesity reviews
,
11
(8), 553-559.
Slide25Healthcare today – lack of sleep
25
Jones, J. M. (
n.d.
). In U.S., 40% Get Less Than Recommended Amount of Sleep. Retrieved October 13, 2016, from http://www.gallup.com/poll/166553/less-recommended-amount-sleep.aspx
Slide26Healthcare – Effects of sleep deprivation
26
Slide27Healthcare – Sitting is a major issue
27
Americaninfographic
. (
n.d.
). Retrieved October 13, 2016, from http://www.americaninfographic.com/post/93519029569/sitting-is-killing-you-infographic
Slide28Healthcare today – functional movement
28
Squats: A Great Daily Exercise for People of All Ages. (
n.d.
). Retrieved October 13, 2016, from http://fitness.mercola.com/sites/fitness/archive/2016/05/20/squat-exercises-benefits.aspx
Slide29Where does chiropractic fit?
Slide30Six phases of public health
6 major approaches to public health practice implemented between ancient times and the contemporary era, defined more by important milestones than by convention. These approaches
are:(
1) public health as health protection, mediated though societies’ social structures;
(
2) the shaping of a distinct public health discipline by the sanitary movement (“miasma control”); (3) public health as contagion control; (4) public health as preventive medicine; (5) public health as primary health care; and (6) the “new public health”—health promotion
Awofeso
, N. (2004). What’s New About the “New Public Health”?
American Journal of Public Health
,
94
(5), 705–709
.
Slide31European Public Health Research Paradigms
Paradigmatic worldview
Characteristics
Positivist or post-positivist
- Knowledge is conjectural
- Based on empirical observation
- Reductionist (measurement of variables) in nature
- Knowledge based on theory verification / refutation
(Social) Constructivism
- Knowledge based on understanding and interpretation
- Focus on social processes and cultural / socio-historic antecedents
- Researchers position themselves within the research
Advocacy/ Participatory
- Politically and empowerment oriented
- Collaborative methods of inquiry
- Aims to ‘give voice’ to minority or oppressed groups
- Focused on changing processes, policies and practices
Pragmatism
- Focus on consequences of actions and solutions to problems (what, how, and what works?)
- Pluralistic (adopt multiple paradigms depending on the situation/ problem)
- Real- world oriented
Slide32Natural vs. Artificial
BJ Palmer, “Answers”; 1952, p. 324
Slide33What is a “normal” chiropractic encounter?
Pathogenic only?
Salutogenic
only?Both pathogenic and
salutogenic
?
Think-pair-share
Slide34Homeostasis - Claude Bernard A French Physiologist
There is an identifiable set of physiological parameters that defined the normal internal state of the organism. Implied in this theory was the hypothesis that the body would seek to maintain these parameters.
“Milieu Interieur”
(“The Environment Within
”)
Gross, C (1998) Claude Bernard and the Constancy of the Internal Environment.
Neuroscientist.
Vol 4(5). 380-385.
Slide35Homeostasis
35
Slide36What is wellness?
"
an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable. It requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning."
H.L. Dunn
High-Level Wellness
(Arlington, VA: Beatty Press. 1961), 6
Slide37Modern day implications
37
Allostasis
Allostasis vs. Allostatic load
Limbic system
Memory/consciousness
Slide38Allostasis
“the
concept of
allostasis, maintaining stability through change, as a fundamental process through which organisms actively adjust to both predictable and unpredictable events.
Allostatic
load refers to the cumulative cost to the body of
allostasis
, with
allostatic
overload being a state in which serious pathophysiology can occur
.”.
McEwen, B. S., &
Wingfield
, J. C. (2003). The concept of
allostasis
in biology and biomedicine.
Hormones and behavior
,
43
(1), 2-15.
Slide39Allostasis
This can be carried out by means of alteration in HPA axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term.
Allostasis
is essential in order to maintain internal viability amid changing conditions .
Slide40Dr. D.D. Palmer’s views
Slide41Chiropractic hygiene
“Chiropractic hygiene is the science of the preservation and restoration of health by retaining and restoring normal functions.”
Palmer, D.D.
The
Chiropractor’s Adjuster, 1910, p.859
Slide42Contemporary definition of hygiene
1. The
science that deals with the promotion and preservation of
health
.
2
. Conditions and practices that serve to
promote or preserve health
.
The American Heritage Dictionary of the English Language, 2000
Slide43Chiropractic hygiene
“The restoration of
natural
conditions, as far as possible, in the midst of civilized circumstances, is the meaning of the word
hygiene
in chiropractic.”
“Hygiene,
chiropractically
, is the restoration of
natural
and healthful environmental conditions which have been made abnormal by the necessities of civilized life.”
Source
: Stephenson,
Textbook of
Chiropractic
, 1927, pp. 133-4 (via Dr. Victor
Strang
.)
Slide44Diet and nutritional hygiene
“The restoration to normal, of conditions made abnormal by unwise educated living; restoration brought about by a wise, sane, and normal educated mind, coordinating with Innate mind as it should, is
nutritional hygiene
."
Stephenson’s “Chiropractic Textbook”, p. 129
Slide45Nutritional Hygiene
“…nutritional hygiene is not dieting but common sense. It is simply the restoration of normal and natural environmental conditions. With this aspect of dieting Chiropractic agrees. ”
Stephenson’s
Chiropractic Textbook
, p. 129
Slide46Diet as a treatment
“When dieting is done with the idea of
curing
dis-ease, or as an arbitrary attempt to regulate the intellectual processes of metabolism, it is acting contrary to every fundamental principle of Chiropractic.”
Stephenson’s
Chiropractic Textbook
, p. 128
Slide47Chiropractic hygiene
Slide48“Getting Sick People Well”
Correct, by hand only, the mal-positioned vertebral subluxation.
Release pressures upon nerves.
Permit a restoration of the imprisoned power supply from
above-down, inside-out
.
Let it have free flow normally.
When it reaches
dis-ease
, ease follows of its own accord.
B.J. Palmer,
Palmer’s Law of Life
(The Palmer School Press 1958), 138-139
Slide49Which One is True Wellness?
Slide50Let’s take a look at chiropractic
50
Slide51Chiropractic in Sweden
Chiropractic in Sweden is not part of mainstream medicine and GPs cannot refer patients for chiropractic care in the same way that they refer patients for physiotherapy as chiropractic is not included in the public health care system.
Westin, D., Tandberg, T., John, C., &
Axén
, I. (2013). GPs opinions and perceptions of chiropractic in Sweden and Norway: a descriptive survey.
Chiropractic & Manual Therapies
,
21
, 29. http://
doi.org
/10.1186/2045-709X-21-29
Slide52Chiropractic in Sweden
Therefore it is challenging to compare referral patterns between the two countries. In Norway chiropractic is accepted as a viable option for patients with
musculo
-skeletal problems and is recommended by 79% of the GPs.
This is almost twice the referral rate as in Sweden.
Westin, D., Tandberg, T., John, C., &
Axén
, I. (2013). GPs opinions and perceptions of chiropractic in Sweden and Norway: a descriptive survey.
Chiropractic & Manual Therapies
,
21
, 29. http://
doi.org
/10.1186/2045-709X-21-29
Slide53Chiropractic in Sweden
The
conditions for which Swedish and Norwegian GPs refer patients to chiropractors are similar in the two countries. Acute and chronic low back pain with or without radiating leg pain were the conditions chiropractors were deemed competent to treat, which is consistent with the available evidence and for the scope of chiropractic care.
The large difference in referrals for
paediatric
chiropractic care between the countries might be due to the fact that the ban on treating children in Sweden was only recently lifted, thus no tradition exists for this option.
Westin, D., Tandberg, T., John, C., &
Axén
, I. (2013). GPs opinions and perceptions of chiropractic in Sweden and Norway: a descriptive survey.
Chiropractic & Manual Therapies
,
21
, 29. http://
doi.org
/10.1186/2045-709X-21-29
Slide54Chiropractic in Sweden
Poor knowledge and not being certain of the effectiveness of chiropractic care were the most common reasons for GPs in both Sweden and Norway for not referring to a chiropractor. It is likely that poor knowledge and doubtfulness about the benefits of chiropractic care are influenced by each
other
.
Westin, D., Tandberg, T., John, C., &
Axén
, I. (2013). GPs opinions and perceptions of chiropractic in Sweden and Norway: a descriptive survey.
Chiropractic & Manual Therapies
,
21
, 29. http://
doi.org
/10.1186/2045-709X-21-29
Slide55Chiropractic in Sweden
The negative comments from the Swedish GPs may offer some insight into why the referral rates in Sweden are lower than in Norway. The GPs’ comments about different levels of education are justified because that is the case and a cause for concern in Sweden
.
Westin, D., Tandberg, T., John, C., &
Axén
, I. (2013). GPs opinions and perceptions of chiropractic in Sweden and Norway: a descriptive survey.
Chiropractic & Manual Therapies
,
21
, 29. http://
doi.org
/10.1186/2045-709X-21-29
Slide56Gallup – Palmer Annual Report 2015
56
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of
Chiropractic.
www.palmer.edu/gallup-report
Slide57Gallup – Palmer Annual Report 2015
57
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide58Gallup – Palmer Annual Report 2015
58
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide59Gallup – Palmer Annual Report 2015
59
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide60Gallup – Palmer Annual Report 2015
60
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide61Gallup – Palmer Annual Report 2015
Main Reasons Some Adults are Unlikely to See a Chiropractor
I have another healthcare provider I would go to – 33%
I don’t trust chiropractors – 29%
I don’t think chiropractic is safe – 23%
Chiropractic care requires too many visits – 19%
I don’t know what to expect when I see a chiropractor – 18%
61
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide62Gallup – Palmer Annual Report 2015
62
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide63Gallup – Palmer Annual Report 2015
63
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide64Gallup – Palmer Annual Report 2015
64
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide65Gallup – Palmer Annual Report 2015
Desired Services at Chiropractic Visits
Spinal manipulation/adjustment – 91%
Manipulation/adjustment of other joints – 81%
Rehabilitative exercise – 76%
Therapeutic massage – 75%
Advice on how to be healthy – 68%
Heat and ice therapy – 65%
Fitness or exercise planning – 55%
Diet and nutrition planning – 30%
65
Source:
2015 Gallup-Palmer Inaugural Report: Americans' Perceptions of Chiropractic.
www.palmer.edu/gallup-report
Slide66How Chiropractors Think and Practice
66
McDonald, W (2003)
How Chiropractors Think and Practice.
Ohio Northern University. p. 15
Slide67Subluxation Research – Student perspectives
67
Gliedt et al. (2015) Chiropractic identity, role and future: a survey of North American chiropractic students.
Chiropractic & Manual Therapies.
23(4) 1-8
Slide68So what is an ideal student?
68
Philosophy
Life long learner
Industry ready
Patient-centered
Clinically competent
Service oriented
Slide69Subluxation
69
Slide70Subluxation
“The concept of vertebral subluxation is central to chiropractic.”
Terret A. (1987) The Search for the Subluxation: an Investigation of Medical Literature to 1985.
Chiropractic History
7(29) 29-33.
Slide71Subluxation
“There is nothing inherently dogmatic or anti-scientific in the notion that an articular lesion may have health consequences, or that correction of a joint dysfunction may relieve symptoms and/or health.”
Keating,
J et.al. (2005) Subluxation dogma or science.
Chiropractic and Osteopathy
1186/1746-13-17.
71
Slide72Subluxation - Categorically
“Currently there appears to be a lack of consensus in chiropractic concerning the exact nature of the subluxation…However, common to all definitions currently in use within the chiropractic profession is the notion of a
structural and/or functional disrelationship
with some form of
neurological involvement
.” (emphasis mine)
Lantz, C (1989) The Vertebral Subluxation Complex Part 1. An Introduction to the Model and Kinesiological Component.
Chiropractic Research Journal
. 1(3):23-36.
Slide73Chiropractic and Autonomic function
73
“Healthy world for mankind is to make sure the autonomic system is not in a continual sympathetic state and adopt way to naturally enable the body for health and restoration…not for defense.”
Porges
, S. W. (2011).
The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation
. New York: W.W. Norton.
Slide74Subluxation – Dr. Irvin Korr
We now know that an increased sympathetic tone in the
nervous
system sets off a cascade of autonomic processes as if the body was being attacked.
T
his
increase in sympathetic tone increases stress hormones known as catecholamines (adrenaline and noradrenaline) and decreases relaxing hormones such as serotonin and relaxin.
Korr IM.
(1976) “
The spinal cord as organizer of disease processes”
Journal of the American Osteopathic Association. Sep
;76(1):35-45.
74
Slide75Chiropractic adjustments and autonomic function
“Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain”.
Results:
The results of this study suggest that CSM
(after one adjustment) affects
regional cerebral glucose metabolism related to sympathetic relaxation and pain reduction
.
Plausible
that subluxation (because of decreased segmental movement) creates abnormal proprioception into the
brain (
specifically the hypothalamus) leading to increased sympathetic tone
.
Ogura, T et al. (2011).
Cerebral metabolic changes in men after chiropractic spinal manipulation for neck
pain.
Alternative Therapies Health Medicine.
17(6) 12-17.
75
Slide76Chiropractic adjustments and posture
76
“Hyperkyphotic Posture Predicts Mortality in Older Community Dwelling Men and Women: a Prospective study”.
Results:
Older men and women with hyperkyphotic posture have higher mortality rates
.
Kado
, D et al. (2004) Hyperkyphotic
Posture Predicts Mortality in Older Community Dwelling Men and Women: a Prospective
study.
Journal of the American Geriatrics Society.
52(10) 1662-1667.
“The Impact of Positive Sagittal Balance in Adult Spinal Deformity”
Results. In all 352 patients studied,
ALL
measures of health status showed significantly poorer as C7 plumb line deviation increased.
Glassman, SD et al. (2005)
The Impact of Positive Sagittal Balance in Adult Spinal
Deformity.
Spine.
30(18) 2024-9.
Slide77Force Sensing Table Technology
77
What we know:
There is variability of forces in the profession.
We don’t know if this is a result of practitioners capacity to control force.
How does this impact patient safety?
Is there an optimal force for treatment optimization?
Slide78Force Sensing Table Technology Outcomes
78
In as little as a 2 hour training session we can train students to modulate forces on demand across very large spectrums of forces. Students just need the force feedback, and coaching.
(
HECQO, 2014)
This not only holds true for students but for field practitioners as well. With force training field doctors performances of adjustments are also malleable with force feedback training.
(
Triano, 2015)
Slide79Force Sensing Table (special preview)
“Influence
of open-lab attendance on student performance using force sensing table technology
(FSTT)”. Poster accepted at 2017 ACC-RAC conference
Hollandsworth, Armstrong, and Russell
Findings:
Students who attended open-lab
were
8 times more likely
to meet the target preload on their first attempt vs students who did not attend
and
were
6 times more likely
to meet preload
overall
79
Slide80We are late…
Slide81Eat, Move, Sleep…and Think?
Slide82#UBU