President's Report

Peter Werth

In many of my previous reports I have looked at some of the issues that I see facing the chiropractic and osteopathic professions. Some of these issues include our role as spine care experts, the role we have in managing chronic spinal pain and the management of paediatric patients. In looking at many of these issues there is a common thread amongst these issues that underlies much of the debate that our professions engage in, often quite vocally. That is… the role of the spinal adjustment.

For some in the professions the adjustment to treat the vertebral subluxation is paramount and the key, if not, sole focus of their practice. For others the role of the adjustment is minimal, with some practitioners virtually choosing not to adjust at all. (For the sake of the discussion I would include all forms of adjusting, from manual, instrumented and other forms of low force techniques). The key point in this is what the practitioner is attempting to achieve with the adjustment, and this usually comes down to their philosophy of practice. Those whose philosophy revolves around correction of vertebral subluxations to optimise the body’s innate ability to heal itself and embrace a wellness philosophy I see are at one end of the spectrum and those that see it as a procedure to improve spinal mobility as part of a broader management regime for spinal pain incorporating rehabilitation and a biopsychosocial approach would be considered to sit at the other end of the scale. Many practitioners would sit somewhere between and hence the diversity of philosophy and practice that certainly encompasses chiropractic. From my understanding the issues are quite similar for osteopathy as well, but possibly with not quite the extreme views. For the patient with acute lower back pain shopping around for a chiropractor or osteopath it’s just pot luck as to what treatment they will receive.

The “art” component of our treatment will in all likelihood, ensure that no two practitioners will work in exactly the same way, meaning that no practitioner’s choice of technique and skill level will be identical when performing an adjustment/manipulation. That is not to say standardising treatment procedures should not be attempted, but it is an onerous task. From my understanding other healthcare disciplines place significant emphasis on standardisation of procedures, and this may be seen as area of deficiency for the chiropractic and osteopathic professions. However at the other end of the consultation - the history and examination, one would hope for a measure of consistency between practitioners. Being able to take a history and undertake an examination to screen for red flags, yellow flags and potential contraindications for manipulation should be essential for all practitioners in order to provide the most appropriate treatment (or referral) for their patient.

In the age of accountability, having a better informed patient population, expectations of third part payors not to mention the reality of having to practise somewhat defensively via employment of risk management strategies (such as obtaining informed consent and screening for vertebrobasilar insufficiency), it would seem self-evident that most, if not all of the above tasks are undertaken by all practitioners routinely.

In the past COCA has provided much of the above information in risk management modules, which are being updated this year.

The COCA Executive has been very mindful of the need to provide practitioners with the essential information to address these issues, but has also sought to develop continuing education material that addresses the developing areas of chiropractic and osteopathic practice such as rehabilitation and biopsychosocial aspects of practice. The evidence is growing for the use of such approaches in chiropractic and osteopathic practice. I believe that it is vitally important for the professions to remain up to speed in these areas, and not risk the chance of becoming a “one trick pony” via the virtual sole use of the adjustment/manipulation. We are in the process of addressing these topics as well as practice management and health screening initiatives that can be integrated into the current practice paradigm. Keep an eye out for these new developments this year.