The chiropractic profession has taken a long and winding road to come into what it is today.1 This rich history is part of what makes chiropractic such a unique discipline. As chiropractic students it is important for us to understand where the profession has come from for us to help drive it forward in the future. The history of manipulation is just as colourful as that of chiropractic.2Manipulation is an inherently therapeutic experience for patients as is evidenced by its longstanding use in ancient times.2 Even though some tenants that had been adhered to early on in chiropractic have been proven unscientific it is important to not ignore them so we can avoid making similar mistakes in the future and objectively determine, via scientific research, what conditions we can have a meaningful impact on.
Manipulation is not a new practice by any means with evidence pointing to manipulation being performed as early as 600 BCE.2 Early theories largely pioneered by Hippocrates revolved around traction and extension forces used to perform spinal manipulations.2 The use of manipulation was widespread and common practice among physicians until 18th century England when difference of opinions on the etiology of back pain efficacy caused division among health care professionals.2 This caused the majority of European physicians to abandon manipulation leaving a small minority as well as lay people known as bonesetters to practice manipulation.2 Manipulation fell out of the mainstream and became regarded as dangerous.2 All this turmoil created by conflicting theories lead to poor patient outcomes for back pain.2 This need for viable treatment options left the door open for the eventual resurgence manipulation largely due to the economic opportunities for medical practitioners while the western world was being settled and bonesetters over the world gaining prominence.2 However, the large majority of medical doctors at this time still opposed manipulation setting the stage for conflict in the future. 2
Conflict is also present within the chiropractic profession. One source of this conflict comes between so called traditionalists who believe metaphysics has a place in chiropractic practice and rationalists who believe the opposite.3 Metaphysics is a branch of philosophy which aims to question the an existing assumptions.3 Metaphysics as it relates to science deals with the fundamental nature of being, the essence of life and challenges scientific theories by providing alternate theories.1,3 Alternative theories can be useful because it prevents us from accepting current theories as dogma, however if you accept only the metaphysical theory you are creating a dogmatic heuristics in your practice.3 Traditionalists incorporate metaphysical values into their chiropractic practice and believe that even though these metaphysical concepts cannot be proven they are true and should not be questioned.3 Rationalists believe that because metaphysical concepts are inherently not provable that they have no place in chiropractic practice.3 This conflict between the traditionalists and the rationalists lead to an anti-scientific attitude in some of the traditionalists which has left a lasting mark on the profession as unscientific.1,3
Regardless of a chiropractor’s personal beliefs it is important to be aware of the history and origins of the profession. If a chiropractor is not informed when it comes to these aspects of the profession they cannot truly understand the profession. It is however very important for chiropractors to know where they stand on the issues that have created conflict for the profession and have a rational justification for their stance, especially when it comes to inter-professional interactions and educating the public.
1. Principles and practice of chiropractic (Reserve) / editor in chief, Scott Haldeman ; associate editor, Simon Dagenais ; section editors, Brain Budgell … [et al.] [monograph on the Internet]. [place unknown]: New York : McGrawHill, 2005; n.d. [cited 2017 Feb 21]. Available from: CMCC Library Catalogue (OPAC)
2. Ciolfi M, Grice A, Kinsinger S. Ancient History of Manipulation [Lecture notes as PowerPoint]. CP 1102: Foundations of Chiropractic Principles and Practice, Canadian Memorial Chiropractic College. 2015 [cited 2017 Feb 21]. Available from: https://courses.cmcc.ca/portal
3. Coulter I. Metaphysics, Rationality and Science. JMPT. 1993 Jun; 16(5): 319-326.