We appreciate your interest and time, and hope to present concise and accurate information to address any (though likely not all) questions you may have about chiropractic, and about what Dr. Zen does as a practitioner.

There is actually a good deal of information on the science of chiropractic, our methodologies, philosophy and treatment presented in layman’s terms on some of the other pages of this website. However, here we provide information about the impact of chiropractic history on interdisciplinary relations, and research on chiropractics. We present this information not only in response to interest express by medical professionals, but also to help professionals consider appropriate conditions for referral to my office.

What You Think May Be Wrong

Most people have an opinion on chiropractic, whether it is due to personal experience or that of a friend or relative, or whether it is one formed by the media and a lack of information. Simply put, if chiropractic is nothing but placebo and parlor tricks, why do Medicare and third-party payors cover chiropractic treatments? If chiropractic is so dangerous, why is the average chiropractic malpractice insurance $4,000 a year, versus the medical average of $90,000 a year? Why is chiropractic offered to our men and women in uniform on military bases around the globe? Why are so many members of the community so dedicated to chiropractic? Why are doctors of chiropractic gaining hospital privledges across the country, and why are DCs such mainstream components of integrated health care departments? Why are we primary care practitioners in most states? Why are DCs even doctors at all?

The answer is, despite a host of challenges to the profession (including difficult relations with other health care providers, an antagonistic media, dishonest and unscrupulous members of the chiropractic profession, and a different scope of practice in almost every state in the U.S.), chiropractic works. Why, when, how, or for what it works is arguably still unclear, despite a host of studies and journals and a century of anecdotal success with almost every condition imaginable. If it didn’t work, then physical therapists would not be lobbying for the right to apply spinal manipulation to their patients, and medical doctors wouldn’t be taking weekend seminars in mobilization and adjusting treatments.

Why Do You Think That Way?

We are all guided by biases based on our personal experiences. Beyond open mindedness, in any given situation a person only has the information available to them to make evaluations and decisions; if you’re like most other people, you find there is not time to do your own investigation in search of the most accurate and neutral sources of information, especially concerning things that don’t bear directly on your life. However, your training as a scientist demands a skeptical position, one which is vital for the continuation of improving health in patients. For many years, the American Medical Association was engaged in an carefully designed campaign to discredit chiropractors, to deny chiropractic licensing, and to orchestrate a public opinion campaign against us, which the AMA named “The Committee on Quackery.” A part of the outcome of this is that generations of fine allopaths in this country were misled, as a part of their education, that chiropractic was voodoo, and that we were dishonest charlatans concerned only with financial gain. Most medical doctors of this opinion probably think this way because they were mis-educated to think it as an extension of the agenda of a few MDs at the AMA. Unless you are a chiropractic patient yourself (we treat many allopaths) you probably have no experience with chiropractic and so have nothing to go on except what you were taught in your education or residency. It is sad to say that today medical students, in most instances, are taught nothing at all about what chiropractors do, what we their credentials are, or when to refer to us.
In 1987 a federal judge found the AMA guilty of antitrust practices against chiropractic, which resulted in some positive outcomes. First, the direct challenge stopped, although years of strategic media critiques had lasting effects, and remain today. Second, for the first time the AMA was forced to acknowledge its behavior in print and to apologize for the action. Third, for the first time money was made available for research into the chiropractic lesion, its diagnosis, and its treatment. Fourth, it gave chiropractors hope for being able to serve more patients with the tools and researcdh they had been given. Finally, the desire for respect drove a renovation of the chiropractic education, which today consists of four years of coursework and internship, taught largely by MDs, using medical textbooks, four national board exams in fifteen subjects, and status as primary care practitioners.

Unfortunately, there are also lasting negative effects that continue to impede the growth and accessibility of chiropractic. One of these is the deep internal division over professional goals, evidenced in part by our two national professional associations (American Chiropractic Association and International Chiropractic Association), which have significant differences in philosophy and practice. Much of this stems from the insecurities that such a long and intense attack from the AMA fostered in the profession. Today there are chiropractors who are intent upon gaining status and recognition, who lobby for titles and degrees like “Chiropractic Medical Physician,” and who wear white lab coats and stethoscopes, though Dr. Zen sticks to the Aloha Shirt. Ironically, part of the chiropractic community today is striving to acquire all the status symbols and behaviors that have been driving many people away from the medical system; the level of clinical detachment and egotistical manner that so many doctors (most notably published MDs like Bernie Segiel, Rachel Remen, and Larry Dossey) are urging their profession to surrender.

Another major hurdle for chiropractic is the difference in scope of practice and the differences in practice from practitioner to practitioner. You can imagine, this lack of uniformity not only presents a tremendous challenge to the creation of positive public opinion, how to explain to our allopathic peers what we do as chiropractors, and makes the efficient design of chiropractic research difficult. One chiropractor may implement cryotherapy, trigger point treatment, and general long-lever mobilization of the patient, whereas another will focus on diagnostic procedures, with or without X-Ray use (we do not employ X-Rays in our office, but occasionally refer out for X-Rays) and one or two highly specific, low-amplitude, high-velocity short-lever adjustments. Even more complex, both may get great results with the same patient.

An important question for you to ask, in service not only to the health of your patients, but to your own health, is how did you develop your opinion of chiropractic? In the end, you and Dr. Zen share the same responsibility to send patients wherever the research shows there is help for them, whether it is surgery, prescription medication, chiropractic, or tango dancing! The best interest of the patient is our highest priority and it is one we know you share as a fellow medical professional.

Research to date

As of the 2004 publishing of the fourth edition of Robert A. Leach’s The Chiropractic Theories, A Textbook of Scientific Research, a Medline search of chiropractic and randomized controlled trials or hypotheses yielded over 3,000 references. That, in comparison to the struggle to find any useful references in the first edition in 1980, represents a paradigm shift for the profession. For chiropractors, it is a given that the chiropractic lesion exists and that reducing them is a significant intervention; we have more than a hundred years of clinical anecdotal experiences with this. However if there is to be andy evidence-based justification for what is done in the over 60,000 chiropractic treatment rooms in the U.S., this trend in research needs to continue, though the challenges to design “useful studies” remains.

Even in 1980, there was a substantial body of medical knowledge, specifically in the realms of biomechanics, neurology and soft tissue pathologies that described and explained the clinical entity being effected with the chiropractic adjustment. However the chasm between professions and chiropractic’s long history of “faith-based” terminology and perspectives aligned us in peoples’ minds more with magnetic healers and crystal therapists than with rational, scientific practitioners or clinical diagnosticians. The fact that the “subluxation” (our name for the chiropractic lesion) describes different stages of the sprain, strain, disc degeneration, facet syndrome, and osteoarthritis is something that has been obscured by interdisciplinary communication problems and the lack of funding for chiropractic research. Ironically, subluxation is now an 800-series medical ICD-9 code which chiropractic interns are taught not to use due to its history as an ad-hoc, faith-based entity.

Recently, Dr. Zen’s alma mater, Palmer University, the RAND Corporation have been awarded a $7.4 million grant by the Congressionally Directed Medical Research Program. This grant will fund a four-year research project to assess chiropractic treatment for military readiness in active duty personnel. This is the largest single award for a chiropractic research project in the history of the profession and will be used to conduct the largest clinical trial evaluating chiropractic to date. Because musculoskeletal injuries are among the most common for military personnel and may reduce levels of performance and readiness, the study will assess the efficacy of chiropractic treatment for active duty military personnel in a number of areas.

At this time, there are a number of active chiropractic theories being researched by those interested in evidence over antecdote about the adjustment. In the realm of soft tissue and biochemical theories, there is the inflammation hypothesis, the instability hypothesis, and the immobilization hypothesis. Several neuropathological hypotheses, including the somatoautonomic reflex hypothesis, the segmental dysfunction/muscle pathology and facilitation hypothesis, the neuropathology hypothesis, the neuroimmune hypothesis, and the myelopathy hypothesis strike closer to the original “pressure on a nerve” concept. Despite the traditional philosophical difference between ‘allopathic vascular supremacy‘ and ‘chiropractic neurological supremacy’, the vascular system plays an important role in many of these, as it does in the veterbrobasilar insufficiency hypothesis. All of these can be evaluated in detail with Leach’s text, The Chiropractic Theories, as a guide.

It is impossible to summarize the research to date. In the Medline results a seeker will find both conclusive and inconclusive, both validating and negating studies; everything from general long-lever manipulation to specific short-lever adjustment studies, from over-generalized studies on lumbar pain management protocols to specific studies on the effect of thoracic adjustments on levels of substance P. Until issues of scope of practice, inter-examiner consistency and research funding are addressed, we are unlikely to see more useful studies. In the meantime, we will have to make decisions based on more demographic analyses on safety, work hours lost, recovery time, and cost of treatment.
Treatment Plans

The general chiropractic approach to a presenting complaint obviously varies from practitioner to practitioner and with the demographics of the patient base. That said, there are standards of care and common practice that every DC must observe which are common to all disciplines. The first step in patient care involves an exhaustive personal and family history followed by a general physical exam and specific investigations relating to the chief complaint or complaints. Acute or traumatic pain invites differential diagnosis to rule out fractures, dislocations, gross instabilities, and hemorrhage. Nontraumatic pains require ruling out tumors, infections, arthritides, or visceral referral.

At Zen Health Center, Dr. Zen strives to avoid the pitfall experienced by doctors of all disciplines; seeing every complaint as a nail because he has a hammer. We understand and treat patients knowing that not every pathology is a chiropractic neurological problem. Treatment plans vary too widely to reasonably discuss here, with totally different approaches dictated by type, duration/age, location, and severity of injury and the involved structures, whether ligamentous, tendinous, capsular, muscular, osseous, or visceral. In an effort to address every issue or pathology as close as possible to its causal level rather than merely at the symptomatic expression, lifestyle factors must be considered and addressed as fundamental.
A 1998 survey of medical physicians indicated that 40% had referred to a chiropractor, and referrals have increased as research continues to lend importance to the role of neuromusculoskeletal dysfunction as a precipitating factor in disease and debilitation. One of the things that is different about Zen Health Center is our focus on collaborative professional care and wholistic treatments for specific complaints. A vast majority of the DCs in Honolulu are what can be considered “straight” chiropractors; they primarily adjust the joints of the spine and sometimes the extremities. In our office, adjusting the spine is a primary focus, however we actively address disorders at all levels possible. For instance, frozen shoulder would be addressed by:

1. Assessing the cervical spine for related radiculopathies and adjusting where appropriate,
2. Mobilizing and adjusting the GHJ where appropriate to restore proper joint dynamics, ROM, and restoration of synovial fluid,
3. Applying soft tissue techniques, electronic muscle stimulation to the GHJ and adhesions within the muscles of the rotator cuff where appropriate, and
4. Assessment of postural/phasic muscle system imbalances with focus on pec minor, teres minor, upper and lower trapezius, and rhomboids with modification of ADLs and prescription of at-home therapeutic exercises to reduce the chances of recurrence
5. Referral outside our office for additional diagnosis and treatment if necessary.

At Zen Health Center, we will only treat patients if they are appropriate candidates for chiropractic care, and only for the conditions reported by a referring professional for (unless other conditions are diagnosed during the physical exam). Other medical professionals will be respectfully regarded as a partner in the process, with regular reports of patient progress and consultations on treatment protocols. Most importantly, once the patient has attained the maximum therapeutic benefit, he or she is discharged.

Patients are encouraged to be self-advocating masters of their own health care. In alignment with this, we provide regular updates to our patients on current research, nutrition and diet, exercise and encourage regular check-ups with their dentist, chiropractor and gynecologist, and support in living a balanced and positive life. There is significant evidence that the mind–body connection is a tremendous resource in health care, and we work with patients to master their experience of their own bodies.

If you have further questions about refering a patient to us for chiropractic treatment, or therapeutic massage, please feel free to send us an email at DrZen@theZenCenter.com or call our office at (808) 599-2700