Wednesday, September 9, 2009

The Beginnings of Upper Cervical Research




1. What surprised you the most when you actually began to work with the B.J. Palmer Clinic (BJPC) files?

As a Palmer student in the 1980's, I had never been given any information regarding B.J. Palmer's research. My perception of B.J. Palmer was more of a showman than researcher. When I began to read through the patient files of the B.J. Palmer Clinic, I was very surprised at how detailed they were, and how well the patient care was documented. I then began to realize what dedication B.J. Palmer had to chiropractic research. He utilized every state of the art tool available in his time, to assess the Palmer Clinic patients before and after their adjustments. Another surprise to me was how infrequently patients were adjusted. Many patient files showed one or two adjustments over months of observation and evaluation. This careful monitoring and follow-up impressed me greatly.

2. How has your work with the BJPC files affected you as a clinician?

I am humbled as a clinician at how carefully the B.J. Palmer Clinics documented chiropractic care. Clinicians often fall into the trap of just writing a bare minimum in the patient file due to time constraints of a busy practice. The message I get from working with the BJPC files is, "document, document, document!" I think most clinicians know the importance of documentation, but if our predecessors could do such a fantastic job of it half a century ago, we should certainly document our patient care perfectly today. Documentation is the key to research, and subsequent dissemination of information about chiropractic care.

3. Do all the cases you're reviewing and working with involve strictly HIO? If not, what types of techniques were used?

In all of the files I have reviewed, including the 1930's-1960's, an atlas or axis adjustment is the only treatment recorded in the files. I have conducted semi-structured interviews with several of the DCs who worked in the BJPC regarding the exact chiropractic procedures used. Each clinician has indicated to me that the adjustments were exclusively Toggle-Recoil (former Upper Cervical Specific) adjustments, usually performed on a side posture table. The knee-chest table was also used, but sporadically. One clinician who worked in the clinic in the mid-late 1950's stated that "when a side posture table wasn't available, or the room was too small for a side posture table, a knee-chest table was used." He also stated that the type of table used was a matter of personal preference, but that it was not a big issue.

4. What have you learned from working with the BJPC files that would make you a better patient educator? Please share that with us!

As a researcher, I want to be very careful about making statements that are not supported by the scientific literature. Working with the BJPC files has opened my eyes to a level of care-giving and patient monitoring that most of us may never live up to in our own practices. Patients came to the Palmer Clinics by ambulance, in wheelchairs, on crutches, and came to be treated at the best, or at least one of the best facilities that chiropractic had to offer at the time. It was a sort of chiropractic ICU. The patients didn't just come for back and neck pain. Around half of the patients, from my preliminary review of the files, came in with viscerosomatic or neuromuscular disease. These people saw the big picture, and came to understand the nervous system's relationship to all body systems. Seeing this in the files has really sparked my enthusiasm for chiropractic and in never underestimating the body's power to heal itself. This renewed spark will carry over into my enthusiasm for patient education.

5. What do you find different about a scientific endeavor guided by a specific set of principles and a specific philosophy?

Pure research or scientific endeavor is simply curiosity, and through that curiosity asking research questions. In scientific research you have to ask those questions, and then report the answers you find regardless of whether your results match your philosophies. Although B.J. Palmer was definitely outspoken on matters of philosophy, I really think he went about reporting what happened in his clinic, and in his studies of field doctors' practices, in a very 'research-minded' way. I will always admire Dr. Palmer for his contribution to our profession, and for working so hard to be a researcher (not an area in which he had training). I hope that all chiropractors will respect the very respect-worthy research that is currently being done in chiropractic. I also hope they will strive to be effective research consumers, keen to the methods of evaluating the quality of the research, and recognizing its strengths and its limitations.

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