The Future of Chiropractic Techniques

Q&A with Dr. Arlan Fuhr
Republished from Jan/Mar Activator Advantage 2007

When it comes to technique, opinions vary widely among chiropractors about what works, what doesn’t, and even if a doctor’s technique is an important choice at all. As a co-developer of one of the most widely recognized chiropractic techniques, Dr. Arlan Fuhr is a unique authority on the development and validation of the adjusting methods that chiropractors use in practice. The following are Dr. Fuhr’s answers to some of the most provocative questions that chiropractors are asking about chiropractic techniques today.

Q: Dr. Fuhr, let’s begin with the fundamental questions of chiropractic practice. Does technique matter? Why or why not?

Fuhr: Obviously, I am of the opinion that technique does matter. In fact, I think the development and validation of technique is vital to our future. We need our techniques validated. It’s a bit foolish to place a ten-year-old technique with no objective clinical research next to a technique that has sought validation by researchers and say that each is equally valid.

In addition, we need to quit hurting ourselves by accepting unvalidated claims and even bad-mouthing competitor’s products and techniques, for sake of the all mighty buck.

Q: Some chiropractors may take exception to what you say about the need for validation. Why do you insist that chiropractors need techniques that have been validated outside of their own clinical experience? What benefit do they get from this level of evaluation?

Fuhr: The benefit is that validation may allow chiropractors to get paid more readily by third-party payers. I think most of us are interested in receiving payment for our clinical expertise, don’t you? For example, I was shocked to learn that many popular chiropractic techniques were considered “experimental” by Aetna Insurance, so they don’t qualify for reimbursement. I found that the basis for Aetna’s judgments was a relatively simple review of the existing scientific literature. Aetna determined that there was little to substantiate the validity or clinical usefulness of these techniques. Lack of adequate research is not a judgment against the usefulness of these methods. Lack of adequate research simply means there’s too little quality data to reach a conclusion about their usefulness, and that determined Aetna’s policy of reimbursement.

Q: Would you say that you’re alone in your emphasis on clinical research as a way of validating a technique?

Fuhr: No. Many technique developers or advocates have spoken of the need for technique research. We’ve been talking about this for the last 20 years. But there’s a huge difference between talking about it and doing something about it. I see a growing awareness among the chiropractors that have participated in Activator Methods programs that technique validation is an incredible benefit. It gives them a sense of confidence in practice. As more chiropractors begin to experience the confidence that comes with objective evaluation, there’ll be a greater demand by individual chiropractors for scientific validation. The first question about any technique will still be “Does it work?” But chiropractors are beginning to impose their own demand for research in their final judgment of what techniques they’ll use in practice.

Q: Do you see the same emphasis on the need for validation in our chiropractic schools?

Fuhr: Yes. Several of our chiropractic colleges have formed committees to evaluate the techniques they’ll teach and employ in their training clinics. I applaud them for having the courage to establish this kind of litmus test. For an example of leadership in our academic institutions, we could look at Ronald Rupert, MS, DC, a research administrator at Parker College of Chiropractic. He has led the faculty in developing a matrix of qualifications by which all techniques must be evaluated before being included in the Parker curriculum. Personally, I would like to see the development of technology evaluation committees that would examine new instrumentation. It’s definitively a need that has arisen as the diversity of our technical expertise continues to expand.

Q: Do you believe your emphasis on research is supported by your work in Activator Methods?

Fuhr: Absolutely. We practice what we preach. For example, I just spoke of the need for instrumentation evaluation. The Activator adjusting instrument was subjected to this kind of scrutiny during our efforts to qualify it for Medicare reimbursement. Of course, much of the original clinical investigations bearing on Activator Methods originated with the Activator company, but not all of the research has been self-initiated. We have also enjoyed the enthusiasm of non-affiliated clinical investigators from a number of corners of the profession. They all have contributed their skills to exploring various aspects of Activator Methods. Activator Methods has undergone assessment of inter-examiner reliability of leg length analysis, of inter-examiner reliability of spinal subluxation detection, and an outcome comparison between instrument adjusting and manual adjusting. So when that chiropractor of the future says, “Does it work?”, we can say “Yes!”, and point to clinical research as well as the anecdotal evidence.

Q: There are many in our profession who view the Activator instrument and Activator Methods as just one of many options in adjusting instrumentation. What does the scientific validation of the Activator approach mean for chiropractors thinking about adding instrumentation to their practice?

Fuhr: Well, imitation is one mark of success, and we now see a variety of new adjusting devices built on the original Activator concept appearing in the trade literature. Not surprisingly there are claims of superiority for brand X over brand Y as each tries to establish a niche in the marketplace. To put it plainly: little of this rhetoric has any basis in hard data. I believe that a recently published Journal of Manipulative & Physiological Therapeutics (JMPT)* paper by Greg Kawchuk, DC, PhD, and colleagues at the University of Alberta provides some clarity on this issue. To download a copy of this paper, visit www.activator.com. They looked at differences among instruments and compared instrument adjusting to manual thrusts in terms of force magnitude and duration. Dr. Kawchuk offers a careful analysis of the data. His balanced overview seems to stand at odds with the claims of the promoters of the instruments. Any chiropractor looking to purchase an adjusting instrument should first scrutinize the company’s claims. What does Activator Methods offer the chiropractor interested in adjusting technology? Our constant work to validate our protocols gives any clinician a level of confidence unmatched by any other adjusting instrument. The literature is there to support this claim.

Q: As a final question, what do you see as the future of research within the development and acceptance of all chiropractic techniques?

Fuhr: I think it can be boiled down to one phrase: the age of accountability is upon us. Once upon a time, formal technique evaluation was something we knew was important, but we thought that we could put it off for a later day. Many believed it sufficient to make our informal observations in our private practices. If something seemed to work, that was sufficient evidence for us to argue its clinical validity and go right on using it. That day is gone.

The time has come when the demand for rigorous, controlled evidence is banging incessantly at the front doors of all healthcare professions — not just chiropractic. The future of clinical chiropractic techniques is in research, plain and simple. I’m happy to say that Activator Methods is leading the way in responding to the call for scientific validation. I know that those who are committed to the use of Activator Methods will benefit in their practices.