Issue 2 - February 2005

Chiropractic and massage therapy
Breaking the language barrier
By Steven P. Weiniger, DC

More than half of the chiropractic practices in America offer massage therapy along with chiropractic adjustments.1 More chiropractic practices have a massage therapist than a medical doctor, acupuncturist or nutritionist combined.

Despite the popularity of massage therapy as an adjunct to chiropractic and the good economic sense it makes to have this alliance, many DCs are frustrated from working with massage therapists.

Why? The answer is simple: Chiropractors and massage therapists have different philosophies about practice and health. And these differing philosophies spill out into mixed messages to patients because these two professionals “speak” different languages.

An example of a mixed message: A DC tells a patient she has a C5 subluxation that is causing her problem, while the massage therapist tells the same patient that her problem is misaligned chakras, congested lymph channels or chronic muscular tension.

The result? A confused patient, wondering what exactly is wrong and causing her pain.

This confusion can be eliminated. The solution is for chiropractors and massage therapists to find common ground and speak a common language based upon biomechanically based principles. The first principle of posture and body motion is this simple truth: The body is designed to move.

In my practice, our goal is to have everyone speak and understand the same language, based upon reality and science. We teach our patients how their bodies work. We have found that patients want to understand how the body works, how you can help it work better and what they can do to help themselves.

And by teaching them some basic mechanics, we also help them understand how both chiropractic and massage therapy work together.

We don’t go into a lot of detail, but we teach patients about the different tissues of the neuromusculoskeletal (NMS) system using a simplified version of Punjabi and White’s2 model from their textbook, Clinical Biomechanics of the Spine.

Punjabi and White organize the tissues of the motion system into three interdependent subsystems:

• Contracting subsystem — the muscles that contract to create motion;

• Connecting subsystem — the skeleton, ligaments, tendons and other connective tissue which provide the framework and hold the body together; and

• Controlling subsystem — the brain, spinal cord, nerves and mechanoreceptors that control the muscles, both consciously and unconsciously.

Best practices from a scientific research, insurance-guideline and patient-benefit perspective include passive care at first, followed by active care. Passive care is therapy given to a patient who receives it without doing anything for himself. Active care involves the patient dynamically moving her body herself.

Although massage has undeniable beneficial effects on the circulatory system as well as on the connecting and control subsystems of motion, its primary focus in on the contracting subsystem.

And while chiropractic profoundly affects all body systems with spinal adjustment, its primary focus is on the bone and joint ligaments — the connecting subsystem.

This model takes into account most of the differing schools of thought regarding chiropractic technique.

For example: The traditional osseous chiropractic adjustment uses a high-velocity, low-amplitude impulse to move the joint into its para-physiological range of motion, stopping short of the injury at the anatomic end range, and thereby removing abnormal restrictive barriers to joint motion, commonly with an audible release.

Although some low-force techniques do not result in joint cavitation, most (if not all) DCs would agree that the goal is to restore a manipulated joint's range of motion and neurophysiologic function and that an adjustment breaks resistance to restore full range joint motion.

Benefits flow from this simple act both locally within the joint (because a joint that cannot move full range cannot nourish itself) and remotely as neurological function is normalized. Nevertheless, the initial intervention is with the joints — the connecting subsystem.

To put this in perspective of the principle that the body is designed to move, chiropractic is passive care of the connecting subsystem and massage is passive care of the contracting subsystem of motion. The chiropractor restores joint motion and the massage therapist restores muscle function.

Once the chiropractor and massage therapist deliver passive care, the patient can go on to active care in the form of daily posture exercises, prescribed by the chiropractor and taught by the massage therapist. This active care more fully rehabilitates the control subsystem and encourages patient involvement past the acute phase of care.

SEND A CONSISTENT MESSAGE

Communication is key to practice success and to good long-term relationships with patients and staff. Patients need to hear a consistent message from the chiropractor, the massage therapist and administrative staff. Using this model, all three players (chiropractor, massage therapist and staff) “speak” the same language to the patient.

It has been observed that chiropractors are our profession’s greatest obstacle to public acceptance and acknowledgement. I frequently see a hodgepodge of practices under one roof without an underlying unifying philosophy.

Ken Wilber, a noted philosopher, observes that things have an inside and an outside.3 When viewed as a profession, chiropractic has an inside and an outside.

Looking at chiropractic from the inside, DCs argue about and attempt to define, a vision for chiropractic.

The public — including the media — looks at chiropractic from the outside and define us as a group. The lack of coherence between our internal vision of chiropractic, and the view from outside our profession, is the cause of much of our profession’s problems.

Historically, chiropractic is about alignment. Aligning chiropractic with massage creates synergies and opportunities for both. If we can align the view from inside chiropractic and the perceptions from outside, we can realize a far greater future than currently envisioned by most of our profession.