Chiropractic + Naturopathic Doctor • September/October 2022 • Creating an Evidence-Based Practice

In my 40+ years in practice, I have continuously pursued the goal of creating an evidence‐based practice, based on quantifiable and predictable clinical improvement. In other words, I was determined to find the holy grail of treatment: 1. Precisely determining the underlying structural or biomechanical cause of the problem, which was producing the symptoms (pain and/or dysfunction). 2. Providing reproducible therapeutic interventions, which would produce consistent and measurable outcomes.

I knew that if I could confidently produce, and demonstrate consistently positive clinical improvement, both I and the patient would know that we were on a path to recovery and resolution, rather than just temporary pain relief. Over the years, I have noted that most patients, even when they were still in some degree of discomfort, would stay with the course of treatment, because they were able to directly experience objective evidence of improvement, such as: improved ranges‐of‐motion and joint stability, as well as normalization of posture, structure and neurological function.

During my studies in chiropractic school, one of my earliest discoveries was that the size of certain osseous structures, such as the tibial plateau, distal femoral condyle, patella, femoral proximal head and acetabulum, or the proximal epiphysis of the humerus on one side of the body, was often larger than its counterpart on the other side. I first noticed this by observing radiographs and cadaver specimens. No one was able to explain these findings. It was only many years later that I encountered the scientific basis for these changes.

Over the years, I was fortunate to meet several researchers and clinicians from various fields of study (cell biology, biomedical engineering, orthopedic medicine, osteopathy, and physical medicine), who were uncovering the underlying effects of injury and biomechanical dysfunction at the cellular, molecular and bioelectrical level. I ultimately recognized that, for any system of therapeutics to be valid, it had to be congruent with this emerging science.

The underlying structure of the body is now understood to be based on the inherent properties of the cytoskeleton and the extracellular matrix (ECM). These ground‐breaking discoveries were made by orthopedic surgeon, Stephen Levin, M.D.1, the originator of the term “biotensegrity”, cell biologist Donald Ingber, M.D., Ph.D.2 and others3. This structural framework, which I have referred to as the Tensegrity Matrix, provides a balance between stability and mobility and explains many of the observed phenomena related to body support, movement, response to stress and trauma, as well as the effects of therapeutic interventions.

As described by Donald Ingber and others 2, 3, the cytoskeleton and the extracellular matrix respond to injury (strain or impact), by expanding at the molecular level. This explains many of the structural and bio-electric changes 4, 5 observed in our clinical research (see: Figure 2).

Finally, I had a proven model for the structure of the body that appeared to explain how tissue expands with injury at the cellular and molecular levels. Research from the University of California has confirmed the fact that bone enlarges with injury, just as I had observed, so many years earlier5. (see Figure 3). Bone has also been shown to cause the bio-electric changes6, which I have found to be a crucial factor in the diagnosis and treatment of these injuries.

One of the major clinical breakthroughs that I and my colleagues were able to accomplish was that bone size appeared to be restored to normal with the type of treatment we had developed. At first, we questioned these results and followed them up with precise measurements using calipers and tape measures. Inter‐tester validation appeared to confirm our findings.

I treated a 15‐year‐old male hockey player, who had been suffering with knee pain for several months, which not only prevented him from playing, but also caused considerable pain during normal daily activities, such as climbing stairs. Fortunately for me, orthopedic surgeons monitoring his condition had taken consistent measurements to within one‐hundredth of a millimeter. They were surprised when the femoral condyle and the tibial plateau of the left knee, which had been approximately 5 mm. larger than its counterpart on the right, had suddenly shrunk by that amount after only a few treatments (see Figures 4 and 5). Subsequently, the young man’s parents noted that he was once again ‘flying up’ the stairs with absolutely no pain. This case verified my contention that normalization of the shape of the bone is possible and appears to allow for the restoration of articular structure and function.

One of the underlying concepts of subluxation theory, is that bones ‘go out of place’. This concept has long been questioned and it is my belief that the entire premise may simply be a matter of mistaken identity. By this, I mean that the palpatory perception of vertebral misalignment may, in fact, be the result of enlargement of part of the vertebral segment (see Figure 6, below). The fact that many patients achieve benefit through spinal manipulation, may be due to its influence on this osseous enlargement, albeit inadvertently, on the part of the practitioner. I am now of the opinion that, if practitioners were made aware of the fact that injury actually alters the shape and size of bone in the spine and throughout the body, they would be eager to apply methods that would more precisely target these areas and thus achieve even better results.

Through a combination of relentless questioning and evaluation of measurable, objective changes in my own practice and those of my students and colleagues, I was gradually able to evolve a method to identify and resolve many of the structural effects of injury and thus improve our clinical outcomes. Over the years, this protocol has been recognized by a growing number of clinicians and researchers from various fields. I have been gratified to note that many of them have been able to reproduce the same measurable outcomes, which I observed.

My goal has always been to develop techniques that can provide profound and lasting solutions to many of the painful and limiting conditions afflicting the public. By integrating the latest developments in cellular biology, molecular biomechanics, and bioelectricity, I am convinced that we can improve upon the care we already provide and evolve even further to provide truly evidence‐based therapeutics. I believe that this will allow spinal manipulation and structural therapy to take its rightful place in the field of physical medicine and health care in general.

Dr. George Roth has been practicing as a chiropractor and a naturopathic physician for over 40 years. He has taught at chiropractic, naturopathic, medical, osteopathic, physical therapy and medical schools throughout North America. He is the co‐author, with Kerry D’Ambrogio PT, of Positional Release Therapy (Elsevier, 1997), and the author of The Matrix Repatterning Program for Pain Relief (New Harbinger, 2005). His work is also featured in the Brain’s Way of Healing, by Dr. Norman Doidge (Penguin, 2016). For more information, visit: www.matrixforpractitioners.com.