Part II and III Boards

Now that the drama of part II and III boards have passed, life can go back to normal... until May. Part IV is coming right up in May and this section is an expensive/difficult practical exam that must be passed the first time. The good thing is that part II and III are done for now.

It was interesting how relaxed I felt taking these exams. Only a few moments of anxiety were felt as each exam was taken. This anxiety was primarily due to not knowing the answer to the question and having to guess. Nobody likes guessing, but this was not that frequent, so that is good. One section of part II had a lot of guessing, which was Principles of Chiropractic. This section was quite useless and completely theoretical, although interesting to some extent.

The nice thing about going through these tests was it sort of defined what chiropractic really is. My take on it is this: it is a profession that largely consists of musculoskeletal specialists sprinkled with a few romantics who feel that they must justify their work with a complex neurological explanation that is really hard to prove. The principles section painted this picture for me because the other sections were largely based in differential diagnoses in both general health/disease and neuromusculoskeletal.

Some of the theories are interesting if you read them with an open mind. Like the over-stimulated sympathetic nervous system. I find that very interesting. Apparently, the thoracic vertebra house the sympathetic chain neurons and from this theory, joint restrictions can cause a heightened sympathetic tone of the muscles, which means a constant fight-or-flight state. Another big theory that we do not study at Western States was the cord compression theory. This theory suggests that with cord compression from the "subluxation", depending on the area being compressed, specific symptoms will follow. My impression of this theory from reading about it on the exam was that it is minor-myelopathy. We've learned many times if you compress spinal cord structures you get myelopathic symptoms such as, spastic paralysis, heightened deep tendon reflexes, loss of bowel and bladder function and an uncoordinated gait. Say you reduce the load, so to speak, but still have compression on an area of the cord. Could this cause low grade deficits? From a logical point of view, I would tend to agree that this could happen. Hence, the reason we use the McKenzie exercises to help reduce pressure on the cord/spinal roots if symptoms are present.

That being said, since many of these major cord compression issues develop over a long period of time, could prophylactic chiropractic care be used to prevent these issues? If so, at what frequency should patients get adjusted? Every month, 3 months, 6 months, a year? And when should treatment start? At the onset of symptoms or in an asymptomatic status? Unfortunately, there is no research that I know of, that has helped define this dosage of care. Prevention via chiropractic remains a very controversial subject in health care.

If we approach our preventive argument through logical thought processes and suggest that adding mobility to an immobile spine could reduce the occurrence of myelopathic, orthopedic and radiculopathic problems, then yes, I could see people buying into the idea. However, if we say that the subluxation is the cause of all disease and therefore, we should eradicate it via regular chiropractic adjustments, expect rejection and continued distrust by the public.

It was pretty clear from taking the boards, that our profession has adopted more of a medical model than once thought.

All for now