Chiro.org REPORTS HERE a Paper written by Scott Haldeman, D.C., M.D., PhD. presenting excerpts from his "Keynote Presentation at the International Conference on Spinal Manipulation." His paper effectively outlines the scientific and theoretical evolution associated with the chiropractic profession. These are but brief excerpts of a longer article. Readers are encouraged to review the article in its entirety at the above link.

"I thought that it would be of interest to younger researchers and clinicians to present my views on how the profession has evolved to its current position in society and how this evolution has impacted our understanding of chiropractic."

"Chiropractic, in its early stages, had some very colorful and interesting theoretical perceptions. ... It was also widely believed that everybody should be seeing a chiropractor on a regular basis even if they were healthy. This concept led to the situation where chiropractors became outcasts to the medical system. ..."

"The last 2 decades have seen a dramatic change to a situation where chiropractors are now widely accepted and have high quality scientific meetings that are often cosponsored by medical institutions. Chiropractic has spread from the United States throughout the world to the point where there are now more chiropractic colleges outside the U.S. than inside the U.S. The acceptance of chiropractic has been so successful that the annual conferences by the World Federation of Chiropractic are cosponsored by the World Health Organization (WHO). As further indication of the acceptance of chiropractic, a WHO Collaborating Center Task Force on the Cervical Spine and Related Disorders has been established, with a number of individuals with chiropractic training included on the various panels. Chiropractic has moved rapidly from the outskirts into the mainstream of health care."

"In the early part of the Twentieth Century, there were many traditional treatment approaches that had been offered to patients for years. Manipulation had been practiced almost since the beginning of recorded history. The practice of medicine consisted primarily of a variety of herbs, extracts and metals which had been handed down from practitioner to practitioner with limited effectiveness. Surgery consisted of crude methods of treating injuries and wounds and attempts to remove diseased organs and drain infections. All of these traditional practices were based on clinical tradition and experience and almost all of the theory supporting their use was speculative with very little scientific support. Clinicians of the day were required to speculate or postulate on the mechanism by which these treatments could be successful. When patients said they felt better after treatment, it was considered a good treatment. Clinicians had to guess at the reason they were treating in a certain way based primarily on their training and experience rather than any true evidence to support the treatment approach."

"Treatment of spinal disorders at the beginning of the Twentieth Century consisted of mobilization or immobilization of the spine. Basically, the patient was placed in a brace with bed rest or given manipulation and exercise. The theories referred to restoring motion and thereby relieving inflammation, putting vertebrae in place and relieving neuro-vascular compression or interference. Classic chiropractic theory of that time described the effect of the adjustment in terms of putting vertebrae in place and reducing nerve compression. Classic osteopathic theory referred to putting vertebrae in place and thereby reducing vascular compression. The theory held by many medical practitioners suggested that manipulation increased vertebral motion and somehow reduced inflammation."

"... there was a general recognition by chiropractors of the importance of science. ... There has always been an interest in scientific investigation by chiropractic institutions and leaders it’s just that the understanding of scientific principle and the training and resources available for scientific investigation was very limited. D. D. Palmer made this point by defining chiropractic as “the science of healing without drugs.” One difference between chiropractic theory and that held by the mainstream medical community during the early years of the Twentieth Century was the incorporation of vitalistic concepts into the perception of the mechanism of healing. ... the body had the innate ability to cure itself if given the specific treatment offered by these clinicians. It was not necessary to know exactly how this happened. The promotion of these concepts was occurring at a time when the mainstream health professions were intensely trying to make some sense of the physiological and pathological processes through which the body could become diseased and treated."

"The mid-Twentieth Century was a period of major theory development. ... it appears to the casual reader that everybody was developing a new theory to explain how the spine worked and could be influenced by the various treatment approaches. The primary basis for many of these theories was pathology. There was a strong tendency to describe the disorders that could impact the spine in pathological terms. Scientific investigation was carried out in order to prove or disprove a popular theory of the time. It was not uncommon for a scientist during this period to start with a theory that had a long history and set out to scientifically prove its validity. ... Much of the research of this period was carried out to prove a particular widely held theory. Osteopaths set out to prove osteopathy, surgeons attempted to prove the basis for many surgical procedures, and so on."

"This development of theory also occurred in chiropractic institutions and at times became very disruptive and led to a loss of unity within the profession. It was comforting to many chiropractors to have a single vitalistic theory behind which all chiropractors could unite. But suddenly D. D. Palmer’s old theories of nerve irritation were revised .... Suddenly there were all of these new theories and concepts as chiropractors tried to explore and explain what chiropractic was and how it worked. This led to a very difficult, conflicting, dogmatic approach to health and spinal care both within chiropractic and between chiropractors and other health care professions."

"The basic thought process was the same, however, in most professions; you believed therefore you treated. If you believed that discs herniated, pain had to originate from discs, therefore treatment was surgical removal of the discs. If you believed that posture and spinal mechanics changed and were important, pain must result from abnormal posture and aberrant mechanics, and therefore treatment must be manipulation and postural exercises (or something similar). If you believed that spinal joints degenerated, pain was assumed to be from pathology in these joints, and treatment naturally consisted of manipulation, or, in the medical field, injections. If you believed that discs degenerated, pain must be from internal disc disruption, and therefore you had to fuse these discs or ablate them with various intradiscal treatments. If you believed that spinal muscles were prone to pathology, weakness, or spasm, the treatment of choice would be exercise, manipulation, or massage depending on the clinician’s perception of the procedures that would impact these muscles."

"I’ve been to many medical and chiropractic meetings where a panel would be made up of a series of believers—the surgeon and his belief, the chiropractor and his or her belief, the osteopath and his belief. ... Unfortunately, none of these clinicians would really talk to each other or even understand what other members of the panel with a different point of view were talking about. During this period of history the chiropractic community continued to have a major interest in research but unfortunately was not publishing very much and was having difficulty both in reaching a consensus and presenting its point of view to the public."

"It was in the 1970s that the first formal interaction between chiropractors and medical physicians in an academic forum took place through the auspices of the NINDS (National Institute of Neurological Disorders and Stroke) which was asked by the U.S. Congress to organize a conference on spinal manipulation."

"It was a very exciting meeting and it opened up the whole field of research into chiropractic and manipulation. ... one basic conclusion was reached and verbalized by Murray Goldstein in the proceedings as follows: “There are little scientific data of significance to evaluate this clinical approach to health or the treatment of disease.” ... chiropractors had no science that could be used to justify their clinical practice and theory and the medical profession had nothing to justify its criticisms."

Chiropractic "became the only profession to evolve, producing increasing numbers of researchers and searching for sources of funding. It was this decision to advance research into the theory and practice of chiropractic that resulted in the position the profession finds itself in today—dominating the field of manipulation research and establishing validity for its practice."

"The end of the Twentieth Century and current times have seen another stage in the thinking of the role of research in the practice of chiropractic. This has become the era of scientific investigation. There is still a need for scientific exploration of traditional theories, but now these theories are starting to come together to form a more coherent picture. Chiropractic researchers ... are working together in multiple academic disciplines to formulate well thought out theories on the impact of the adjustment and manipulation on the body. There is also a convergence of theories between chiropractic and medical researchers in a number of fields such as the three joint complexes, spinal disc disease and stenosis, the myofascial syndromes and central pain mechanisms."

"There has been dramatic change in thought process both from a clinical and from a scientific point of view over the past 100 years. In the early years of chiropractic, practice drove theory ..."

"During the “middle ages” of chiropractic, theory drove science."

"Today we are starting to enter the era where science is driving theory. Scientists and clinicians are developing new theory out of the scientific knowledge that is evolving. This new theory is based on the results of prior scientific investigation. At the same time, clinical research is beginning to drive practice. What we are allowed to do in practice and what we will be permitted to do in practice in the future will be dependent upon what we can prove to be effective."

"It must be realized that scientific research is forming the basis of the theories that direct further research and which therefore direct clinical practice. ... Right now chiropractors can go before any audience and say that there is sufficient science to discuss the neurological and clinical effects of the adjustment. It is no longer credible for anyone to state that “there is no scientific basis for spinal manipulation or the chiropractic adjustment.” ... The theories on which chiropractic is based are evolving and I believe that we are entering the most exciting time in chiropractic’s theoretical history. I think we’ll find that the people who are doing research will discover physiological processes we have not yet considered and they will develop much more exciting theory than we have today. This will lead to more exciting practice and much better ways to treat—and explanations on why and how we treat—our patients in the next 10 or 20 years."

"The primary factor that will determine the speed that is likely to occur is the commitment by the chiropractic profession in the research process. This requires that individual chiropractors become more involved by reading the scientific journals and attending meetings where the results of research are presented. Research, however, is dependent on financial support. The results of research will benefit chiropractors and their patients more than any other group. It is therefore essential that chiropractors financially support institutions that fund research. It is only through such funding that the theories and practice of chiropractic will continue to evolve and the practice will improve to the benefit of all chiropractic patients."