important elements that give chiropractic a unique edge. A time may come when people are ready for more in-depth in-struction. Until then, communicating the potential chiropractic has for offer-ing tangible benefits to a wide spectrum of patients can begin as simply as pre-senting these points. EFFICACY AND SAFETY Unbeknownst to many, and in addition to the subjective testimonials of hun-dreds of thousands who feel they have been helped by their DCs, a plethora of studies are available to demonstrate the efficacy of chiropractic treatment in a variety of (mostly) musculoskeletal con-ditions and injuries. 1,2,3,4,5 One can also find some preliminary studies that sug-gest chiropractic might have effects on other conditions as well, either inciden-tally or directly. 6,7 At the same time, there are stud-ies that demonstrate where chiropractic might not be useful or where it is, in fact, completely contraindicated. 8,9,10 This, too, is important information. Furthermore, there are studies in chi-ropractic and medical literature indicating that chiropractic is a safe form of treatment that has been utilized by hundreds of thousands of patients 11 without reported side-effects or adverse outcomes. 12 Again, in an effort to carefully consider both sides of every coin, there are also reports of bad outcomes or side-effects. 13 These are few, however, when compared to the number of treatments that have not caused harm. 14 (Even the most ardent skeptics must con-cede that any procedure, including the most common medical procedure, carries some risk.) My point is simple: in an age when evi-dence is king, and the medical profession bases its credibility on its ongoing scien-tific collection of evidence for efficacy and safety, chiropractic is neither lacking in evidence of these traits, nor less passion-ate in its systematic pursuit of best prac-tices, evidence-informed treatment and delivery of safe, patient-oriented care. In fact, in light of some of the challenges the profession has faced, it has become espe-cially adept in managing these elements. 15 HOLISTIC APPROACH The natural/manual healing systems (commonly known as complementary or alternative) offer two appealing elements www.canadianchiropractor.ca to a public that is increasingly seeking safe and effective alternatives to conven-tional care 16 : they harness natural means to heal or to maintain health, and they do so in a holistic manner. This holistic approach actually is opening some roads for the profession to communicate in an increasing spectrum of health-care-related dialogues. One ex-ample of these is within the area of work disability prevention and rehabilitation. Dr. Patrick Loisel is a medical doctor and professor at the Division of Occupa-tional and Environmental Health, Dalla Lana School of Public Health, University of Toronto. He has recently also come on staff at the Canadian Memorial Chiroprac-tic College (CMCC). Dr. Loisel is an ex-pert in the field of work disability preven-tion. A prolific writer and researcher, he is a prominent voice in this area of health care where millions of dollars continue to be spent annually, with limited results. At CMCC, it is Dr. Loisel’s mandate to set up a graduate program in work-related dis-ability and prevention. He is pleased and intrigued to have the opportunity to do so in a chiropractic setting. One of the reasons for this is chiro-practic’s inherently holistic approach, which he feels can be beneficial in light of the varying situations presented in this field of study and treatment. Work dis-ability issues, particularly as they pertain to return-to-work, are often multifaceted, and often have less to do with the actual injury than with other factors relating to the individual. Dr. Loisel feels chiroprac-tors’ holistic approach to care makes them well-suited to work with those who have been injured in work-related incidents, and to assess and treat their injuries, and also to help guide these patients back to their optimal work situations. “A chiropractic school trains chiro-practors who are first-line health-care providers dedicated to disorders of the musculoskeletal system,” says Dr. Loisel, in an interview with Canadian Chiroprac-tor. “These disorders generally give pain, and this pain may be relieved by chiro-practic care. “However, some cases may be resis-tant to chiropractic or other treatments and are associated with sick leave from work, sometimes leading to disabling pain. Modern science has shown that, most of the time, these cases are often not explained by a local disorder, but by a conjunction of personal, workplace and social factors that become, in fact, responsible for the work absence, result-ing loss of worker’s role, quality of life and financial burden for workers, work-places and society. “This requires a broader biopsycho-social and multiperspective vision of the musculoskeletal symptoms when they do not heal with usual treatment,” con-tinues Dr. Loisel. “This requires explora-tion of more complex dimensions of the personal, workplace and social life of the affected person and to build an ap-propriate management plan involving stakeholders beyond the usual binomial relation patient-care provider. Chiropractic training already transmits a holistic vision of disease and care and this new train-ing should find fertile ground in young chiropractors following the planned advanced course.” Work-related disability is just one area where chiropractic can harness its basic principles, with an eye to benefit-ing patients while garnering attention in other health care circles, and with the public, without compromising or water-ing down its raison d’etre. ADDRESSES WIDESPREAD AND COSTLY MUSCULOSKELETAL ISSUES There is no lack of studies and reports discussing how chiropractic can impact many of the costly musculoskeletal ill-ness and injury situations that seem ubiquitous in our society today. 17,18 The profession of chiropractic, particularly in Canada, must be congratulated for its achievement of collating, and continu-ing to refine, this information in such a meaningful way. The question, therefore, is no longer whether chiropractic can help with these problems. The question is how may we position chiropractic as a preferred and/or primary route for addressing these issues in a health-care milieu where several other groups aspire to similar goals. Work is being done, within the profession and beyond, to help stake this claim for chiropractic; the results of this work will be important for the profession. However, one of the biggest factors that will help the profession make in-roads will be its persistence in its efforts at meaningful and repetitive communi-cation – with the public, legislators and political bodies, as well as other health CANADIAN CHIROPRACTOR | APRIL 2011 • 9
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