|Home | About | Journals | Submit | Contact Us | Français|
Physical manipulation and manual therapies are thousands of years old. The most popular western world iteration of these therapies is delivered by chiropractors. It can be argued that the collective public health benefit from chiropractic for spinal pain has been very substantial, however as chiropractic has transitioned from craft to profession it has encountered many internally and externally driven machinations that have retarded its progress to a fully accepted allied health profession. This article sets out a ten point plan for a new chiropractic that will achieve full acceptance for this troubled profession.
This article is based on a keynote speech known as the FG Roberts Memorial Address delivered on October 10, 2015, in Melbourne, Australia at the Chiropractic & Osteopathic College of Australasia and Chiropractic Australia national conference.
The ten point plan consists of the following: improving the pre-professional education of chiropractors, establishing a progressive identity, developing a special interest for the profession, marginalising the nonsensical elements of the profession, being pro-public health, supporting the legitimate organised elements of the profession, improving clinical practice, embracing evidence based practice, supporting research and showing personal leadership.
Adherence to this fresh ten point plan will, over time, see the chiropractic profession gain full legitimacy in the allied health field and acceptance by other health providers, policy makers and the public at large.
Manual therapies including manipulation have been used for centuries, indeed even thousands of years . Many cultures have practitioners that administer these manual therapies for musculoskeletal pain and they can be variously classed as traditional healers including bone setters in England, Kung Fu masters in Asia, and more lately osteopaths, chiropractors and physiotherapists in the western world [1, 2]. Traditionally these manual therapies were taught father to son, mother to daughter, or master to apprentice and in some cultures this still occurs [1–3]. Although this article concentrates on chiropractic, much of what is discussed has implications for other manual therapy professions.
Chiropractic is 120 years old and in that time has progressed from a full alternative medicine concept to be part of complementary medicine and in some jurisdictions it has primary care status. Some argue that historically chiropractic has elements that are consistent with religion . Regardless, what can be said is that the profession’s history, conduct and overall contribution is chequered by “good” and by “bad”. The “good” can be summed by recognising over a century of improvement to public health by improving pain and disability in countries where chiropractic is practised. It can be asserted that this has provided significant economic savings and improved productivity. There has been important global benefit from chiropractic treatment and although this has not been estimated it must be very substantial. The profession can hold its head up high when reflecting on this positive population benefit over time.
Before moving on to the “bad” aspects practiced by a minority within chiropractic I contend that the global “good” produced by the profession far outweighs the “bad” and this point should not be ignored when reading this article. The “bad” side of the profession has been the subject of much controversy, publicity and indeed previous F.G. Roberts addresses [5, 6]. Table 1 lists some of these “bad” practices that continue to cause significant reputational damage to the profession.
Currently there are many countries that have registration and licensing for chiropractors and educational programs with somewhat differing standards and emphases, housed mostly in private colleges but with a minority in government funded university programs. There is some limited private health funding for patient consultations, minimal public funding for patients, very little hospital access, and research that can only be described as embryonic. The profession by and large graduates competent manual therapists who contribute well to their communities and are good professional citizens, but there are still aberrant elements with a profound retrograde ideology. These individual and organised elements have caused the profession untold reputational damage and continue to do so. As a consequence the professions reputation is commonly poor among other health professions with whom it is compared and its approval is variable within the community at large.
So with all this in mind how does the profession progress to make it equal and worthy partners in the health arena? A profession where it can command a healthy respect by others in the health sector, policy makers and patients alike? A profession where it is welcomed as a legitimate partner in health care delivery?
To achieve this the profession has a stark choice. It can maintain the status quo, keep on the current track and forever be regarded as alternative or complementary practitioners who are just “different”. Or it can develop a vision for a new chiropractor who has the recognised attributes of a fully worthy and functioning allied health professional and contributes more in their respective health field than others do. This article aims at achieving this goal.
To advance the profession globally over the next generation and to achieve the vision set out above a ten point plan is proposed. It is recognised that even if the plan is adopted it will take this significant additional time of a generation to succeed. Hopefully young members of the profession are sufficiently motivated to take on this cause and see it through. If they do, the reputation of the profession will be enhanced to the extent that chiropractors and chiropractic will be seen as legitimate partners in the health care delivery system. It is reasonable to speculate that this goal matches the aspirations of our younger professionals as they look forward to a long and virtuous career.
A ten point plan to fully legitimise the chiropractic profession.
With the adoption of this ten point plan the chiropractic profession has an opportunity to turn things around within a generation. Importantly, it has an obligation to the public and to successive generations of chiropractors ahead of it. By embracing this plan the profession can be set on a new path, a new beginning and a new direction. This plan should be known as the new chiropractic.
Associate Professor Bruce Walker (BFW) is Editor-in-Chief of the journal Chiropractic & Manual Therapies. This article was peer reviewed and BFW played no part in the editorial process involving this article.