The Power That Made the Body
Today is the most exciting day to be a chiropractor. It always has been---at least since September of 1895---and it will always remain so. For that matter, today is the most exciting time to be an electrician, stockbroker, psychologist, or schoolteacher. For every day that we are alive we are, hopefully, appreciating---savoring--- the greatest gift we will ever be given. The word "chiropractic" means "done by hands," but I suggest that, if we read between the lines, it really means "done by Life," with a capital L. May we all, regardless of our age or time in practice, remain students of life, and of a human’s ability to live and celebrate life fully.
Harvey Lillard’s story has been told, thankfully, millions of times. The take-home point, for years, has been that this first chiropractic patient was not a low back pain patient but a man who was cured of deafness through a series of chiropractic adjustments. As I see it, today, the take-home point of that story is much larger: our patients, clients, or practice members – whatever we want to call them – need not have neck pain or back pain to merit a visit into our offices; they only need to be alive and desirous of experiencing aliveness, inner growth, and a fuller tapping of their potential than they ever dreamed possible. That's my "chiropractic story" as I am sure it is many of yours.
Another reason why it is the most exciting time to be a chiropractor, specifically in the second decade of this new millennium is that nearly every day we are receiving great news about the "playing field" of our profession – namely, the central nervous system – from the esteemed halls of academia. The hot topic these days, waiting to be replaced by the next hot topic in the neurological sciences, is that of neuroplasticity--- the brain and spinal cord’s ability to reinvent itself. It wasn't long ago – I remember well being taught this in chiropractic college myself – that we were told that if the central nervous system was damaged in any way, those precious tissues were lost to us forever. Today we know differently. We are now coming to realize just how "plastic" or adaptable our brains and nervous systems truly are.
Do you recall from your college days learning about the sensory and motor homunculus, that weird looking diagram of the brain with strangely proportioned body parts above it, indicating how much space was dedicated in the brain to receiving sensory information from the depicted parts and how much space was dedicated to moving them? The cortex, or surface area of the brain, is mapped out into different sections that correspond to every area of the body. Each part of the body has a little space devoted to it, although the areas aren't always lined up next to each other the way the foot is next to the ankle, or the elbow next to the shoulder but, rather, according to how much sensory information they send to the brain and how much of the brain can be relied on to respond to this input. Thus, the large hands and fingers and the odd looking lips.
Dr. Daniel Amen, the popular scientist who appears regularly on PBS, has written about the use of a nuclear medical brain-mapping device called SPECT imaging, which can accurately visualize neuroplastic changes occurring in the brain as it is being rehabilitated following a stroke. Another brain expert, Dr. Paul-y-Rita, went a step further and created his own device that helps the brains of people with damaged vestibular function or balance to read the external signals of where they are in space through receptors on their tongues. Dr. Norman Doidge, in his fascinating book "The Brain That Changes Itself," is a treasure trove of information on neuroplasticity, much of which will confirm what has always been known about the power of the chiropractic adjustment.
By now most of you are probably familiar with the story of Dr. Jill Bolte Taylor, the neuroanatomist who suffered a severe left hemispheric stroke and was actually able to experience firsthand the gradual loss of that side of her brain and then the subsequent recovery of function during her rehabilitation. Her book "My Stroke of Insight" is a must-read regarding this subject.
Yet another leading researcher on brain neuroplasticity, Michael Merzenich, has shown in his work that the brain is tremendously more adaptive and efficient than we ever realized. He discovered that the size and shape of the homuncular brain maps, mentioned earlier, change according to how frequently they're exercised, and how they are exercised in particular functions. The "use it or lose it" adage is just as true with the brain as it is for the leg muscles of a marathoner.
There's been so much research done in recent years on neuroplasticity of the brain that even our patients, so-called laypersons, can avail themselves of the research and apply it to their lives on their own. Doing so requires a basic understanding of the sensory and motor function of the nervous system and the fairly simple rules of playing the game called, to borrow the title of one of Dr. Amen's books, "Change Your Brain, Change Your Life." And a significant piece of information emerging from this research is that not all sensory input into the brain has the same quality and/or duration of beneficial effect. For two remarkable books on this matter, look no further than chiropractor Dr. Robert Melillo’s “The Disconnected Kids” and “The Reconnected Kids.”
Dr. Bruce Perry, a specialist in treating trauma in children, has discovered that certain types of slow, intentional, and repetitive movement, usually involving calming music, enable the higher functions of the frontal lobes to process the therapeutic issues at hand more effectively. As a result, more therapists are using this kind of movement in groups before beginning cognitive, or talk therapy, sessions. These therapists are referred to as "body-centered psychotherapists" or "somatic psychologists."
Dr. Malik Slosberg authored an excellent article in 2010 entitled "Cortical Neuroplasticity with Spinal Manipulation, Exercise, Injury and Pain." It appeared in Dynamic Chiropractic and broached the subject of how chiropractic can assist with neuroplasticity. The emphasis, however, was on what Slosberg called "motor-skill training" as the focus of care in improving the organization of the sensory-motor cortex. There was a study mentioned that showed short-term improvement, around 20 minutes, in the sensory motor cortex subsequent to chiropractic adjustments. This is exciting news which warrants further exploration. The fact, however, is that there is not much research pointing to anything but short-term improvements in brain function following chiropractic care compared to the numerous studies showing the effects of slow, intentional movement and its effects on brain activity.
It is true that injury, inflammation and pain arising from spinal joints not only affects the individual joints involved, as Slosberg points out, but also has a significant impact on the function and structure of both the sensory and motor cortices. He cites studies that show that acute pain with injury, as well as chronic pain, reduces gray matter in numerous parts of the brain: the prefrontal cortex, thalamus, brainstem and the sensory-motor cortex. Slosberg writes, "In the primary somatosensory cortex in back pain patients, the representation of the lower back is expanded and shifted medially, invading the area where the leg is normally represented." Such shifts in primary motor representation make it easier for the patient to experience subsequent pain and turn into a chronic pain patient. This is not surprising – injury and pain causes a reduction in movement. While every muscle that we deal with in chiropractic is a skeletal, and hence voluntary, muscle potentially under our conscious control, if adaptation to pain causes an eventual loss of sensation in the affected area, we lose the ability to move or self-correct the cause of the pain. As these higher centers in the cortex depend upon movement for their integrity, adverse neurological changes are seen in such cases. What we cannot sense, we cannot move. And what we cannot move, we cannot sense. It is a vicious cycle, one which robs the patient of their ability to heal from the inside out. It promotes the "myth of aging." How many of our patients have gone to medical doctors with back or neck pain, often in their 40s or 50s, only to be told, "What should you expect? After all, you're not as young as used to be." We weren't as young as we used to be when we were three years old! To compound the ludicrousness of such a statement, whenever a health professional suggests cutting back on movement as a solution to pain, they are prescribing future degeneration and, eventually, disability.
We are holistic beings. In a very real sense, new fascial research reveals that when we touch any part of the body we are touching all of it. Similarly, the latest body-mind research indicates that when we touch any part of the body, we are also touching the patient's mind. The ramifications of this are enormous. On the disturbing side, when the sensory-motor cortex is impaired due to a lack of high-quality and quantity sensory information, impairments in memory, language skills, mental flexibility, cognitive function, and decision-making are also observed.
Researchers Haavik-Taylor and Murphy authored an award-winning paper in 2010 in which they described a single session of spinal manipulation applied to dysfunctional cervical joints resulting in improved somatosensory-evoked potential responses at the cortical level in neck pain patients. My concern is that the results typically lasted only up to 20 minutes. Can we do better than this? And can we do better than this without requiring a patient to receive a spinal adjustment every 20 minutes?
We most certainly can, however, it requires us as a profession discovering and orienting to a somatic center of gravity. The word "somatics," as used by the leading proponents in the field describes a "first-person" account of one's body as perceived from within. By clinical extension, it also implies the person's ability to sense contracted, "amnesiac” muscles and their restricting effect on joints – spinal or otherwise – through appropriate movement. This should not be a threatening subject to us. When the chiropractic forefathers stated, "The power that made the body heals the body," they were pointing to a deep truth: that, with or without, the help of an external authority we have the ability to heal our bodies, and even our lives, from the inside out. It doesn’t get any more chiropractic than these nine simple words. Dr. Christopher Kent has said on many occasions, "The purpose of a true professional is to render him or herself obsolete." Of course, people need to be taught how to reconnect themselves to these, for all intent and purposes, "forgotten areas" in their bodies and how to regain control over them. The somatic pioneer Thomas Hanna described these areas as areas of "sensory-motor amnesia," as eloquent a description of the neurological subluxation as any I've ever heard. And, of course, we can and will never be rendered obsolete – there is an endless line of people needing and even wanting to regain better control of their bodies and lives. But it requires something that the profession, to date, is lagging behind in: awareness of and expertise in somatic reeducation. Actually, this is not entirely true. Giving credit where credit is due, Dr. Donald Epstein, the developer of Network Spinal Analysis, has elegantly evolved a somatic perspective in his work with very positive results. And, of course, the ground-breaking work of Dr. Ted Carrick, while not exactly somatic in nature, has demonstrated an entire menu of novel ways of waking the nervous system of many patients up from its sleep.
Slosberg, in his above-mentioned article, reports on other recently published papers in which motor-skill training caused longer-term adaptive changes in sensory and motor cortical organization in chronic low back pain patients. He writes, "Improved motor coordination can be trained and is associated with reorganization of the motor cortex." Bear in mind, however, that motor-skill training require something that lasts longer than the time it takes to deliver a spinal adjustment. This in no way is meant as a criticism of spinal manipulation. The chiropractic adjustment can be used to reduce pain which, by itself, has a constructive effect on the organization of the sensory-motor cortex, allowing the patient to begin their adventure of healing themselves from the inside out in a more comfortable manner. Morphine and oxycodone can also provide powerful, short-term relief. None of these methods, including spinal manipulation, are in and of themselves intrinsically educative, however. The somatic disciplines have, over the last half-century, elaborated distinct and effective methods for empowering the person's nervous system to cooperate with the biological urges of innate intelligence to heal from within.
Some of you may be wondering about my interchanging the terms “adjustment” and "manipulation." In my humble opinion, an adjustment delivered from the outside-in, without taking the time to educate the patient to consciously and purposefully heal from within (and I don't mean the obligatory lay lecture designed to sell patients on the need for long-term care or to get them to refer their friends and families into your office) then that adjustment has just been downgraded to a manipulation.
What is the brain if not an exquisite memory organ? If we always deliver more force from the outside-in that it takes for a patient to release the subluxation from the inside-out, from movement, breath, and deliberate rest, then we have helped their brain to memorize that it always needs an outside force in order to heal, grow and transform. And that is not the chiropractic message that I want to deliver. If, on the other hand, we either use subtler forces in delivering the adjustment – more congruent with the body’s endogenous attempts to self-correct, or incorporate somatic approaches that assist the patient in cooperating with one's innate desire and ability to heal from within, then we have helped the brain to memorize that, indeed, "The power that made the body heals the body."
A chiropractic adjustment releases endorphins, which provide the patient with a temporary decrease or cessation of pain. Slow, purposeful movement – the kind of movement customarily used in somatic education – causes the release of the brain chemical dopamine which plays an important part in stimulating long-term plastic growth of the brain map associated with the activity that produced it. Somatic movement is pleasurable movement and pleasant experience causes the production of more dopamine which makes one want to do more of the activity, which produces even more of the brain chemical. If the practitioner studies and learns the need for focusing these movements on our center of gravity, both horizontally in the abdominal-pelvic region as well as vertically along the spinal axis, not only is the limbic or primitive emotional center of the brain involved but the entire meso-limbic system, which travels down the posterior portion of the spinal cord, as well. Not only does movement improve but, because movement is not simply what we do but what we are, our whole lives can change.
Brain researcher Pascuale-Leone has demonstrated repeatedly that self-generated stimuli, ranging from conscious thought and meditation to purposeful movement, can alter the brain, its neural circuitry and chemical balance, and the life of the brain's owner for the better. He found that the greater use of a certain muscle, the greater the amount of cortical real estate that will be devoted to it. Sometimes, as in dealing with stroke patients, the actual movements cannot be performed. No problem, as Pascale-Leone has shown that by simply visualizing the same intentional activities, similar expansion occurred for that part of the sensory-motor cortex. This should be exciting for all of us who work with people who are handicapped and have limitations in their movement. One of my somatic mentors, Emilie Conrad, the developer of Continuum Movement, says, with regard to "paralyzed" patients, "If you know what you are doing, you realize that these people are not truly paralyzed, but suffering from a temporary suspension in ambulation. What is paralyzed is the medical idea that once a person has suffered such damage to the brain that they are doomed to be at the effect of their injured status forever." I have personally observed Conrad at work in a clinical setting where "paralyzed" patients spending three or four days with her in her "laboratory" in Santa Monica, California learned to be able to sit on their own when a few days earlier that task was impossible.
So what does somatic reeducation in the chiropractic practice, or anywhere for that matter, look like? While it is not within the scope of these articles to teach how to perform such techniques, the somatic educator Anat Baniel (a clinical psychologist who worked closely with Dr. Moshe Feldenkrais, arguably the "grandfather" of somatic disciplines, for many years) describes nine essential ingredients that must be utilized for somatic reeducation to "stick." They are: 1) movement with attention; 2) empowering the client's desire to learn; 3) subtlety and gentleness of movement; 4) variation and novelty of movement; 5) slowness of movement; 6) enthusiasm for the learning process which has an amplifying effect on the movements themselves; 7) flexibility in goal setting; 8) the ability to visualize and imagine new ways of moving; and 9) awareness of what one is doing or how one is moving.
Paying close attention to what one is doing has a dramatic effect on how much space the brain will devote to mapping that area. Apparently, lack of attention does not lead to abiding neurological growth in the brain. How many times have you palpated someone’s spine and found it to move as if it were one long bone. Try performing a simple guided palpation wherein, prior to delivering your adjustment, you touch and name each vertebra in the restricted area so that the brain can fill in the missing gaps, so that it can recognize again that the spine is a flexible column of many vertebrae. This alone can begin to thaw out, so to speak, the sensory-motor amnesia in that area. Somatic work, by the way, need not be done by the doctor. An assistant can be easily trained to attend to this part of one’s practice.
Dr. Thomas Hanna also a longtime student of Moshe Feldenkrais, went on to elaborate his own system of somatic reeducation which has proved extremely effective in correcting the causes of pain as well as promoting greater freedom and autonomy in individuals. In his estimation, as many as 50% of the cases of chronic pain suffered by human beings are caused by sensory-motor amnesia: a condition in which the sensory-motor neurons of the voluntary cortex have lost some or all portion of their ability to control certain muscles of the body. It does not occur as an organic lesion of the brain nor of the musculoskeletal system. It occurs as a functional deficit, what As a Chiropractor I refer to as a "functional” or “neurological subluxation,”: whereby the ability to sense and contract a muscle group has been surrendered to lower, sub cortical reflexes. These reflexes, located mostly in the brainstem as well as the cerebellum, control movement from that point onward, regardless of how inefficient or predisposing to injury it may be.
For well over a century our profession has been struggling with our own version of the "chicken or the egg" riddle. For much of that time we have hung our hat on the "structure governs function" answer to that question. I recall one of my greatest mentors in chiropractic college, Dr. Henri Gillet, sharing his frustration during his own college years when he was told to, in the Palmer Clinic in Davenport in the 1920s, to adjust an asymptomatic patient because a structural misalignment was noted on x-ray. He dutifully did so only to watch, to his dismay, as the patient became ill. He found this scenario to occur repeatedly. Conversely, he was told to leave asymptomatic – musculoskeletal or otherwise – patients alone because their radiograph indicated no structural malpositioning of a vertebra. He nearly left the profession in disgust over such dogmatic thinking. Fortunately for chiropractic, a cousin of his, Julian Gillet, was an osteopath practicing in Belgium who urged Henri to read some of the early osteopathic literature on function governing structure, which he did--- subsequently giving birth to motion palpation and a new paradigm for chiropractic.
In the last ten years, Dr. Gordon Waddell of Scotland was the recipient of the prestigious Volvo award for the best research on spinal pain. His research repudiated the "structure governs function" model. He cited examples where the great majority of asymptomatic people when examined by MRI are found to have clinically confirmed disc lesions. He showed the opposite to be true as well: that when you take a large number of highly symptomatic low back pain patients, their MRI’s will, indeed, show evidence of disc lesions, however, when they are treated and rendered asymptomatic again, the lesions, in most cases, remain. He describes studies in which radiographically-confirmed facet syndromes and cases of sacroiliac misalignment did not symtomatically remit to anesthetic blocks delivered to the the involved joints. A 2011 paper by Lederman, in the Journal of Bodywork and Movement Therapy, entitled "The Fall of the Postural-Structural-Biomechanical Model in Manual and Physical Therapies" demonstrated the fallacy that structural or patho-anatomical evidence of pain has a strong correlation with the cause of that pain.
There is currently a lot of well-meaning discussion regarding what to call the clinical entity addressed in chiropractic. Obviously, we address subluxations. But do we address "vertebral subluxations," "neurological subluxations," "emotional subluxations," "functional subluxations"? One thing is certain: it has always been the intention of chiropractic to improve the quality of the central nervous system and its "conversations" with the rest of the body and to, thereby, allow a human being to heal and express their full potential from within.
Sensory motor amnesia is no more of a medical condition than is the subluxation, whatever we end up calling it. It can only be overcome by education, not by treatment. A process within the individual must occur whereby new sensory information is introduced into the sensory-motor feedback loop and consciously experienced, allowing the motor neurons of the voluntary cortex to regain control of the musculature, allowing their full and voluntary relaxation.
I have come to understand need for a somatic center gravity in my profession because it is quintessentially neurological, and therefore chiropractic, in nature. Hanna’s grounded his work in the awareness of three neurological processes gone awry: the trauma reflex, the startle reflex, and the Landau reflex. Each of these reflexes is different both in its presentation and in its genesis. I’m often asked by a patient, or even by yourself, "If innate intelligence is so doggone perfect why do we need a chiropractor to remove interference to its expression?" Another version of the same question is "If innate intelligence is everything you say it is, how do subluxations develop in the first place?" As you read these words, sensory receptors in cranial nerves are perceiving vibrations that either make sense or do not. When you speak to someone or when someone speaks to you, they are perceiving, through other cranial nerves, sounds in a specific frequency range, that either make sense or not. In a very real sense, the purpose of the central nervous system is to decipher sense from nonsense, or chaos from order. If the sensory input we perceive is interpreted as being in need of a protective muscular response the brain will intelligently orchestrate that. The input might be from within ourself, in response to worrisome thoughts. Perhaps it is in response to extrinsic, or even imaginary, forces or situations that we fear may physically harm us. On the other hand, the incoming information may cause the brain to elicit an arousal response that contracts different muscles than in the preceding examples. The key thing is that when these responses become habitual, chronic contraction of spinal, and other, muscles and, eventually, pain ensues, along with "the inevitable effects of old age." The problem here is that aging is not a pathology, nor does longevity have any relationship to such symptoms, except in the sense that the longer we live, the more stressors we will have dealt with, either in an appropriate or in a subluxated manner.
Whenever a patient comes into an adjusting room three ideas instantly appear as to what should be done: the patient's ("Doc, just crack my neck."); the chiropractor’s (“Based on the following positive orthopedic and neurological tests, Mrs. Smith, you need to see me three times a week for the next month to address the misalignments in your spine."); and the patient's own body. How do we listen to and make sense of what the patient's body is trying to tell us? Perhaps we look at leg lengths, or perform muscle tests, or take an intuitive approach. Recognize that when we look at someone's posture we need not have to examine it in order to look at "what to fix."
A patient's posture is a snapshot in time of the status of their central nervous system: are they in a state of arousal, withdrawal, or, maybe, retraction from real or perceived stressors? Herein lies our entry point into the story that the patient's body desires to be heard. Rarely can the patient verbally articulate it so well.
The word "doctor," of course, means "teacher." Healing is, above all, an educational process. I remember hearing Dr. Patrick Gentiempo state, "If we adjusted every single person on the planet but failed to educate them as to how to live an ‘inside-out ‘life, we have failed as a profession." We are phylogenetically programmed to heal, grow, and evolve from within. However, an ontogenetic layer can be superimposed over this millions-of-years-old innate program through habituation and reflexive learned adaptations. Nothing has happened to innate intelligence. It still possesses all of its qualities and would love for nothing less than our taking the time to notice it, to engage it, to lovingly reorient our lives to it. Educational tools exist and continue to be developed to augment the neurological benefits of the chiropractic adjustment and to provide our patients the means to develop themselves fully from within. There is a superb 2011 article in the Journal of Bodywork and Movement Therapy on the Pandicular Response and how all beings with a central nervous system utilize this neurological response to self-start their day, to correct what may be call subluxations, and to reset their neuro-myofascial system on an ongoing and regular basis. We have all watched a dog or a cat wake up and how it pandiculates before getting on with its day. Birds pandiculate by lifting one wing in a backward direction while also extending the homolateral leg backward. Upon awakening, human beings do the same: they extend their backs, legs, arms, and jaws in the typical morning stretch. In every case, it is directly linked with awakening – it is an ancient sensory-motor pattern of cortical arousal. Pandiculation has even been observed to occur in human fetuses and is believed to be an important part in its early neurological development. This phenomenon does not occur haphazardly, but according to a highly refined neurological sensibility inherent in the organism. It can be orchestrated and nuanced in the clinical setting to achieve startling effects. Muscle groups that may have been in continual contraction for 40 years or more will not only relax but, with the reinforcement of chiropractic adjustments and ongoing somatic practice of 10 minutes daily duration, will stay in a state of relaxation. The changes are both immediate and comfortable.
Some chiropractors push bones around in the hope that it will relieve pressure on the nervous system. Others poke on muscles because, "muscles move bones." However, muscles do not move bones of their own accord. Muscles are the servants of the brain and have no will of their own. If we address our adjustments, educational or otherwise, at the heart of the patient's sensory-motor experience, excellent results – greater cortical control, greater freedom and autonomy, and – oh yeah – relief of pain, should predictably follow.
I haven't changed my mind since beginning article. It is, indeed, the most exciting time to be a chiropractor, because chiropractic is the science of life, and we are---here/now---alive. Please, repeat after me: “Yesterday is history, tomorrow is a mystery, and today is a gift. That's why they call it ‘The Present’.” And chiropractic? It can be the embodiment of that gift.
-Dr. Jeff Rockwell