The State of Chiropractic (and Healthcare in General 2022.)

I’ve been having a hard time with my label lately.

True, I’m a chiropractor, and I’m not ashamed of that, but I’m not a chiropractor in the sense of what your granddaddy would think. 

I’m not really into “alignments” and popping and cracking stuff “back into place.”

In my clinic today, while thinking about this for the 7000th time and explaining this basic setup to a client who was disappointed because I didn’t have a “magic pop” for his six-year-old hip issue, I got the idea for this particular article. 

I’d bet everyone, at sometime in their professional career goes through a identity crisis and is looking for a change or a better understanding. I just wanted this one out there because I see myself repeating this over and over. I still love my job, it’s just mis-understood.

It’s just a small article that may be helpful for you as a client, referring practitioner, AT, friend, or concerned family member.  I hope this focuses your direction if you are a chiropractor or student. It will help dial in exactly what you want to do for a career.   

It’s tough when I show up at our local university, and the professor wants me to explain “chiropractic” –it takes THIS.   A lecture.  Perspective and Awareness.  A modern look and idea into chiropractic.

The problem with searching “chiropractor” on Google.

I’ve mentioned it multiple times on this website, but the chiropractic profession has been and is currently going through an evolution.

 What used to be one profession and is still named as one profession has realistically split into 12 or 15 different subsets.

It’s not unique; it happens to every profession.

Take medicine, for example. 

One hundred years ago, there was “one” doctor.

The same guy who would give you medicine when you were sick would also set and splint your broken bone, deliver your baby, bury the deceased, and probably even look at the goat in the back pasture. There was just one doctor.  One guy in a long coat with a shiny reflector on his head carried a bag full of tools and most likely made house calls as part of his average workday.

That has changed. A century has brought great modifications in healthcare’s evolution. Nearly everything is now specialized.  There’s not ONE type of doctor. You would never ask your OB/GYN (gynecologist.) to look at your shoulder problem.  Humorous, yet it’s obvious because that would take a different specialist.  Still, the ortho and the gyno are both doctors. They may have even gone to the same medical school.  They simply have a different game and a different specialization.

Teachers have specialized.  A high school AP physics teacher would most likely struggle in a 1st-grade classroom.  Yet 100 years ago, in many communities, one teacher was teaching multiple grade levels simultaneously.   Things change. 

The same is true with nearly every profession.  Mechanics, Farmers, Bankers, Lawyers, athletic trainers, Engineers …you get it.    They have the same heading, yet completely different jobs and skill sets.

Chiropractic is like that. My wheelhouse is more along the lines of sports medicine and would probably be much closer in description to an athletic trainer mixed with a strength and conditioning coach. 

My strong suit and typical client is coming in with an acute sports injury or is looking for a maintenance tune-up before a game.  Because of my background as a personal trainer, I have a hybrid clinic with a huge passion for sports performance.  A visit to my clinic would most likely be 20 minutes of muscle work, an assessment of how the hips and the big three engines (link) are moving, looking for energy bleed out with movement, and then because it is a shortcut for mobility, some chiropractic work.   Not for alignment of the spine or hips but to maximize proper body mechanics in order to speed healing or enhance power, agility, and speed.   More of a movement specialist, and truly, with athletes, my mind and diagnostics go into the visit much like an auto mechanics’ head would prior to racing a trophy truck in the Baja 1000.   Nothing broken, but how can I get more out of it?

My skill set would make me a fantastic medical Director for a sports team or even a high-employee work environment. I would thrive at a job like this and feel I’d be the guy best suited for the initial evaluation and exam – detective work – able to run a client through an assessment and then figure out who the best fit is. Does client X need: An orthopedic surgeon, a chiropractor, a physical therapist, a massage, a personal trainer, or better coaching?

I help them find their best path and possibly but not always, I would be that appropriate path.

But I’m being flooded with clients looking for a “crack” to their back. I get it. It feels pretty good, and it’s sort of impressive, our profession kind of made the popping thing our deal, but often I come home and feel worn out because the fix they were looking for isn’t in the pop. I feel like I punted them down the calendar a month. Dr. Salazar, my colleague, see’s how much this stresses me and once joked. “When a customer shows up at McDonalds and asks for a Bacon Cheeseburger and has $10 in their hand, the server’s job is not to remind them that they are Jewish and shouldn’t eat pork. They get them a damn bacon cheeseburger.”

My 14-year-old son is helping me with this a lot because he finally pointed out that being a chiropractor and having that “pop me” label brings me the most stress. People still want and are looking for a simple pop and crack, and that’s just not my style or philosophy.  “Isn’t there something you can crack that will make all my ailments disappear?”  There’s not.  or at least, it’s not me.

Even something simple like a rib out of position takes me two days and involves much more than just a pop.   It’s simply not my philosophy, so I struggle when clients look for that.  

 I feel it’s my job to

 1) try to help them see the reality of their needs and expectations or

 2) help them find who they are looking for if it’s not me.

Chiropractic is simply in the transition phase that the medical profession underwent 100 years ago and continues to modify throughout its evolution. Chiropractic doesn’t have a set list of Specialties at this time. You can still just  Google “chiropractor”  and come up with an easy list. I don’t think that helps you get to the person you want.  Also, It’s confusing and wrong.

A doctor told a client last week, “I prefer a PT to a chiropractor.”  Easy answer.  But, it’s inaccurate as it doesn’t include the end of the sentence….”for this particular issue.”  

It’s based on the assumption that all chiropractors do X and all PTs do Y.

I told this client (as I explaining to MDs, AT’s etc.), “There are probably 3-4 PTs that would be awesome at this issue and 5-6 that would be terrible, same with chiro.   This, however, just happens to be my specialty and will take me 2-3 visits.”

 Last week while lecturing at the University, I asked the classroom of 19 and 20-year-olds, “Would any of you even think of Googling the term “doctor”  when searching for a local MD?”

 The answer was unanimous, “Of course not. You would look for a specialist in your particular field.”

 That’s a problem when our profession doesn’t truly have set specialists named.   Yet.

Here is a brief list of where I think our Specialties sit.

Like every profession, it will constantly be modified and evolved, and I think you can see significant changes every decade.  Understand that each of these chiropractors has a unique and special skill set.  Of course, like any doctor, we all have overlapping ideas yet most likely practice a specialty that makes our clinic unique and completely different from one chiropractor to the next.

Chiropractor Specializations:

Standard adjustment for alignment issues:   Typically labeled as “straight” chiropractors.   They focus primarily on the spine and positioning.  Straight chiros uses Xrays looking for positioning problems and alignment issues. The adjustments for these issue are what chiropractors are known for, and TikTok and YouTube shorts have made this very popular. National chains like The Joint, Hole in one technique, upper cervical, and Gonstead-based chiropractors most closely resemble what the average person would think of as a chiropractor.   

Sports Medicine Specialists:  a hybrid version most often resembling a mix between an athletic trainer, chiropractor, physical therapist, and sometimes, depending on their level of expertise may be coaches and personal trainers.   Often these chiropractors have a lot of experience with extremities like feet, ankles, elbows, shoulders, and hips.    Typically these guys are looking for quick fixes, and you have fewer visits but much more homework and rehab-type ideas.  The exam most often isn’t focused on the joint “alignments” but more closely resembles orthopedic evaluation and often refer to and works with surgeons. X-rays aren’t used looking for alignment but looking for fractures and MRIs for ruptures. These docs (my subset) are looking first for poor movement and mechanics and severity of the injury, with a considerable focus on muscle, joint, fascia, exercise, weakness, and how it all functions together.   Often looking to get a more athletic population back on the field and recovering quickly.    Most likely, these specialists work hand-in-hand with a high school / College athletic trainer, coaches, or a personal trainer. You can find these specialists at nearly every professional sports team.

Personal injury and work comp specialists:    These chiropractors are highly trained to look for problems that have arisen from accidents.    They have detailed assessments, often looking for subtle changes that may be causing both acute and chronic issues. Their exams are very detailed. Because of the nature of these injuries, the treatment plans can be long and extensive.  Because so much of their clientele needs extremely detailed documentation to help transition a client through not only their injury but a “case,” these specialists have a strong suit in exam and documentation and often are very comfortable working with attorneys and HR teams. 

Pregnancy and Women’s health.  These chiropractors have a set niche in motherhood, often specializing in working with the woman’s body throughout pregnancy and immediately afterward. Very often, working in conjunction with the OB/GYN throughout the entire delivery process and the child’s early development.

Pediatric Specialists

Geriatric specialists.    Often these chiropractors are focused on long-term chronic problems and alleviation of pain.   These Specialists tend to be very good with Healthcare outside of traditional adjustments.  One of our local chiropractors, whom we refer to almost daily, uses an “activator technique,” a specialized tool for low Force manipulations of the joint, but also follows a series of protocols to balance out chronic problems.

Deep tissue/Fascia specialists. We are lucky in Texas to have Specialists under the brand name Arrosti, but others include Active Release and Myofascial release specialists. These chiros have a very clear focus on trying to get to the one or two primary restrictions leading to a cascading problem with normal function. These guys get in there deep and have a  finely tuned specialization.   When I explain different sets of chiropractors to my clients, I often bring up Arrosti doctors in my day-to-day practice.   We share many clients back and forth, and it is immediately apparent that we are doing different work.   You may have 5 or 6 doctors, such as a dermatologist for skin issues, an Internist for Colitis, and an ENT for the flu. Many clients seek multiple chiropractors based on their particular case.   It’s no longer a “one for all” profession and most likely never was.

Some chiropractors focus more on massage techniques. There are fantastic Nutritional specialists, specialists with neurological issues like seizures and headaches, and some with a focus more like a physical therapist who works on rehabilitation & injuries after surgery. 

This, in the past, led to some inter-professional squabbles, as classically, PTs were the muscle/rehab people, and chiros were the bone and joint guys. Medical doctors didn’t trust our exams.  This is no longer the case.   This thinking is outdated and aged.  It’s a gray area now.

Just like there are physical therapists that are very good at mobilizations, the lines have been blurred, and it is no longer what your label is that counts. It is what you practice every day.

Most of us working in these fields understand this, but it hasn’t trickled down to the general public yet and sometimes hurts my ability to communicate with some aligned professions in health care.

I hope this article sparks some interest.   I hope it helps clear up some confusion and helps some young students interested in pursuing careers in the healthcare field relax and find a better direction.   

I hope this helps the Athletic Trainers I work with understand that I’m not popping their kids and telling them they can play in todays game because their alignment is good.

I intend to help patients understand better so they can find the right fit for them.  So often, clients contact me, saying, “I was referred to you because of how much my friend liked you.”

They liked me because I don’t see myself as a chiropractor.  I see myself as a detective and am very comfortable with my specialty and subset. 

I’d bet everyone, at sometime in their professional career goes through a identity crisis and is looking for a change or a better understanding. I just wanted this one out there because I see myself repeating this over and over. I still love my job, it’s just mis-understood.

I am more than happy to steer someone in the right direction when I am not the specialist they are seeking—and speaking of that as you are seeking.  It’s probably worth looking at another article I recently put out there…” How to Avoid your Doctor” (which included avoiding me!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s