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Structure vs. Function

© Dr. David L. Phillips

In my last article I discussed that MRI's were revealing a high degree of serious, yet incidental findings on low back studies. These incidental findings, such things as severe disk degeneration, spinal stenosis and bulging disks were found regularly on asymptomatic patients in a recent major study. This result seems rather confounding: if the people studied did not have back problems, and over half had never experiencedthem, why were their spines so compromised?

I notice a similar phenomenon in my office. Patients with simple mechanical back pain are being told such bizarre things after having undergone an MRI examination. The MRI's are not lying, so where and how is this conflict arising?

Perhaps it is a gap in our knowledge and understanding.

As long as we continue to think that the causes of our back pains are structural things that can be demonstrated on films, we will continue to miss the boat.

One of the major differences between a chiropractor examining a spine and a medical physician examining the same spine is point of view. And this is huge! This divergence in viewpoint can be summed up in 2 diametrically opposed rhetorical questions: Does structure govern function, or does function govern structure?

Medically, if a patient has a bad structure, it is widely believed that s/he almost surely will have bad function, thereby be unhealthy or in pain.

Chiropractors do not feel this way. Function, to us, is primary. To us, poor function will surely lead to poor structure. Just as misaligned front wheels on a car will lead to bad tires.

So when a chiropractor looks at a back, s/he looks for smooth running joints, muscle balance and tone, even degrees of motion on each side in all ranges, proper postural carriage, and good feet, among other things. We don't get all excited about degrees of disk thinning, or bone density numbers, or x-ray results that could very well be positional anomalies or merely incidental findings. We check function first, because to us that's where we will find the clues as to how to help. We know that even in the severest cases of spinal degeneration, if we can improve the function of the spine that patient will get relief.

There, I've let the cat out of the bag. Now I've told everyone what the chiropractic secret truly is. The secret to chiropractic is not, as many studies have suggested, in kindly listening or concerned reassurance, the secret to our 108 years of success is that we believe firstly that function is primary and that structure follows function.

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