Chiropractic Principles: Ancient foundations of manual medicine, metaphysics and science
There is evidence to suggest that variations in spinal manipulation have been practiced for the last two millennia (1). In the eastern world, specifically in China, evidence of manipulation therapy dates back to 2700 B.C (1). One technique, depicted as a form of gravity traction, was used to treat the lumbar spine. After having the patient stand on a pile of tiles and hands strapped with a rope to a support above head, the practitioner would apply a force to the lumbar spine region. As this occurred, the tiles would be removed from below the patient's feet on by one (1). In India, joint manipulation was implemented as an act of hygiene. Bath attendants would kneel on the backs of individuals while grasping their shoulders to make the spine ‘crack’ (1).
In the west, it has been argued that Hippocrates was the first physician to describe the technique of spinal manipulation. In particular, Hippocrates identified two early manipulation techniques known as succession, a form of gravity traction, and rachiotherap (1). With rachiotherapy, a table equipped with a rope and lever system applied a pulling force at the patient's arms and legs to generate traction through the spine. While this is taking place, the physician would implement a spinal thrust (1). In addition, Hippocrates continually stressed the relationship between the spinal column and disease causation (1).
During the nineteenth century, many physicians expired the use of manipulations in their practice (1). Individuals suffering from conditions such as sciatica, lumbago, and rheumatism turned to bonesetters to relieve their symptoms, even though bonesetters were often refused hospital access (1). Although the stigma pertaining to spinal manipulations and bonesetters continued throughout the nineteenth century, some medical doctors continued to study and incorporate bonesetting techniques into their practice (1).
Early theories of osteopathy were based around the ideas that the lack of blood flow to a tissue was the cause root cause of disease (1). With this in mind, early practices of osteopathy were based around manipulation. As the profession expanded, the osteopathic scope of practice began to incorporate more traditional medical practices such as obstetrics and surgery, straying from the original practices of manipulation (1). This trend, with respect to osteopathy and manipulation techniques, remained until the late 1950s. It was during this time where manipulation use began to rise once again within the osteopathic profession, accompanying other treatment methods (1). In the osteopathic profession today, manipulation has become a specialty in means of its understanding and implementation strategies by its practitioners (1).
The act of manipulation as a form of treatment may have been among the physical therapy profession since the start of its time. With this however, it was not until the 1990s that manipulation was deemed a distinct treatment method in the profession (1). In more recent times, manipulation in many of its variations and implementation patterns has shown greatest attraction within the physical therapy profession (1). Therefore, inclusive in the physical therapy scope of practice is the various forms of manipulation.
Metaphysics refers to the branch of philosophy concerned with explaining the fundamental nature of being or how things came to be (2). Within the health professions and specifically in the minds of many chiropractors, there is an ongoing battle in the profession between two mentalities. One of which believes that its philosophical roots of the profession should guide the practices of the profession, and the other believing that science should pave the path to what is practiced (2). Although the chiropractic profession has existed for over a century, it has yet to adequately engage in a critical examination of its cherished beliefs and dogmas (2). Consequently, I believe that personal opinions about philosophy and science will continue to dominate the chiropractic profession.
References
1. Haldeman, S. Principles and Practice of Chiropractic. 3rd edition. United States of America: The McGraw-Hill Companies, Inc.; 2005.
2. Coulter, ID. Metaphysics, Rationality and Science. Manipulative Physiol Ther. 1993;16:319-326.
