Journal of Chiropractic Humanities

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Associate Professor
Palmer College of Chiropractic West

Diversified Technique: Core of Chiropractic or "Just Another Technique System"?

Not surprisingly, the term "diversified" has been subject to diverse interpretations in the chiropractic milieu, to the point that it is not even clear whether or not the word should be capitalized. For some individuals, "diversified" is an adjective, in the sense of "eclectic," whereas for others, "diversified" is a noun, representing the name of a specific chiropractic technique system. The issue cannot be explained away as mere semantics, in that the differences in usage underscore divergent historical legacies. The use of the term "diversified" has ranged from an expansive descriptor of the core of things chiropractic, all the way to a restrictive label for just another named chiropractic technique. Qua core of chiropractic, diversified technique is too global to succinctly describe whereas as a named technique, it is too eclectic to distinctly describe. Diversified chiropractic technique is like a close friend with a somewhat fuzzy past, whose true identity must remain unknown until that past is known.

The Evolution of Proto-Diversified Technique

By 1904, D.D. Palmer's original chiropractic institute had re-emerged as the Palmer School of Chiropractic. Between 1908 and 1911, B.J. Palmer introduced - indeed, practically legislated - a number of philosophical and technique innovations, including the "meric system" of diagnosis, the concept of "major" and "minor" subluxations, the restriction of adjusting to five or six of the "main" vertebrae per visit (1, 2), the recoil method of adjusting, limitation of adjusting to the vertebral column alone, the condemnation of "mixing," the advocacy of "straight chiropractic," the belief that virtually all disease is due to vertebral subluxation, and the use of x-ray for diagnostic purposes. Many of these innovations were controversial and engendered opposing viewpoints.

Several schools and individuals vied with B.J. Palmer for control of the profession, including his own father, whose 1910 text, The Science, Art, and Philosophy of Chiropractic, takes many pages (3)(4)

The roots of the diversified approach to chiropractic technique lie within a broad-scope, less personalized reaction to the Palmeresque fundamentalism that emanated from the "Fountainhead" during chiropractic's first several decades. Indeed, the philosophies and methodologies of the loyal opposition - primarily Carver, Langworthy, Smith, Forster, Howard, and "the Big Four" (Firth et al) - amount to a sort of "proto-diversified" technique, even though the methods associated with these individuals remained either deliberately or accidentally proprietary, not yet truly eclectic and depersonalized. Proto-diversified technique eluded B.J. Palmer's attempt to dominate the burgeoning chiropractic profession, many of whose leading individuals did not accept his autocratic position.

Apart from the substantive differences between their methods and those of the Palmer milieu, the loyal opposition conformed to a more mainstream method of accumulating knowledge. Compared to the essentially anti-establishment position struck by Palmer, they stuck closer to, and for the most part declared allegiance to, the existing body of scientific knowledge, which they intended to improve (but not necessarily replace) through the accretion of chiropractic knowledge. Here then, are the roots of diversified technique - not merely a body of clinical practice, but an approach to sustained development. B.J. Palmer greatly accelerated the development of competitive schools of chiropractic by demanding in 1924 that all chiropractors adopt the neurocalometer (3, 5), and in the early 1930s that they abandon vertebral adjusting below the level of C2 (6).

Carver stated in his 1936 history of chiropractic, quoted by Wardwell (7), that "It therefore came about that the Chiropractic profession was constantly disturbed by 'new adjustments'...other inexplicable things, too numerous to record. As a result of the flurries there were 'The Parker lumbar discovery,' 'The Langworthy Method,' 'The Smith System,' 'The Howard System,' and so on, throughout the list of all those who assumed to conduct schools." Carver's distaste for proprietary technique, what Vear has called "technique systems" (8), constitutes an incipient component of the diversified weltanschauung. His openness to more broad-scope practices earned him the epithet "mixer," from Palmer's point of view (9). Carver also objected to B.J. Palmer's insistence that "nerve occlusion" takes place only at the spinal level, holding instead that the nerve stimulus may be "occluded from entering the brain...from transmission through nerve channels...may be occluded from normal application upon tissue elements at the periphery of nerves" (10). Finally, Carver's structuralist point of view (based on body biomechanics) (11), permitted a much more expansive approach to clinical chiropractic than the strictly segmental views of B.J. Palmer.

In 1903 (9) the American School of Chiropractic and Nature Cure at Cedar Rapids, Iowa was founded by D.D. Palmer's student, Solon Langworthy, soon joined by fellow Palmer graduates Oakley Smith (a former medical student, who did not complete the program) and chiropractor Minora Paxson. Their Modernized Chiropractic of 1906 (12), generally credited to be the first textbook of chiropractic, featured elements of gait analysis, motion inspection, nerve tracing, static and motion palpation, extremity adjustment, and postural analysis (2). Clearly, their approach was inherently more eclectic and especially more dynamic than that reflected by B.J.'s "bone-out-of-place" mindset. Modernized Chiropractic adds many technical innovations to the chiropractic armamentarium, including some that B.J. Palmer considered tainted by mixing: traction and traction tables, rib maneuvers, long-lever lumbar adjustments, and extremity adjusting (2). Oakley Smith would go on to found a "naprapathic school" in Chicago in 1906 (6, 13) or 1905 (14). According to Zarbuck (14):

"Naprapathy is a drugless system of treating human ailments discovered in 1905. The theory underlying it is that many of the ailments of the human body are due to a tightened or shrunken condition of a ligament; that such a condition is referred to as a ligatight, and where it takes place near a nerve it brings a mechanical tension on that nerve and induces an abnormal function."

John A. Howard, who had been a student of B.J. Palmer, founded another rival school in 1906, also in Davenport. He was disturbed over Palmer's reluctance to furnish cadavers for the anatomy students to dissect. Moreover, he strongly objected to B.J. Palmer's blend of "Specific, Pure and Unadulterated" chiropractic: "He became overzealous. He claimed that all disease is due to subluxations of the vertebrae and that all diseases could be eradicated by adjustment of the vertebrae. He derided all other forms of therapy, and persisted in his original views to the end" (15), quoted by Gibbons (13). This National School (forerunner of today's National College of Chiropractic) moved to Chicago in 1908, and eventually passed into medical hands when Howard formed a partnership with a medical doctor, William Schulze, in 1910. Dissection, physiotherapy, and much more were introduced into the curriculum. In essence, "These inclusions into the chiropractic core curriculum reflected a different teaching philosophy and an increased amount of attention to other therapeutic approaches that, in Howard's and Schulze's opinions, were necessary for a practicing chiropractor" (6). Although B.J. Palmer certainly believed that Carver was a mixer (9), what really touched off the bitter and never-ending mixer- straight debate were the physiotherapeutics introduced by the National College of Chiropractic: electrotherapy, hydrotherapy, muscle techniques, massage and remedies both internally and externally applied (2).

Although B.J. Palmer's introduction of the neurocalometer was well- received by many chiropractors, many others found it objectionable, whether on the basis of professional criticism or distaste for what they saw as Palmer's price-gouging marketing practices (5). Among these critics were some of the Palmer College core faculty, who according to Gibbons (3) were kept in the dark on the neurocalometer research, although Keating feels this was hardly possible (5). In any case, James Firth left the Palmer school with 3 colleagues in 1926 to found the Lincoln College in Indianapolis, one of the profession's first 4 year schools. The others were Harry Vedder, Stephen Burich, and A.E. Hendricks. "The educational foundation of Lincoln College was based on diversity {emphasis added} of technics of adjusting and the philosophy that interference of innate intelligence could happen, as D.D. stated, anywhere a subluxation could be found. They placed a heavy influence on also learning the basic sciences" (6).

The Crystallization of Diversified Technique

It is safe to say that diversified technique took shape in substance before assuming the appellation "diversified," the origin of which remains appropriately obscure (17). Nevertheless, the classic expression of diversified technique can be either probably (18) or unequivocally (17) attributed to Joe Janse, D.C. There is no doubt that his 1947 Chiropractic Principles and Technic (19) remains diversified technique's crowning achievement. Although the book assumes some fairly revisionist, and anti-fundamentalist ideological positions - e.g., "To say that subluxation is the one and only cause of disease is wrong" (19) - what really qualifies Janse as the mentor of diversified technique is the tremendous scope of clinical chiropractic procedures he describes. Moreover, of particular importance is the way he describes them: Janse was able to present chiropractic diagnostic and therapeutic methods in a generic, non- proprietary manner.

True, Carver, Langworthy, Smith, Howard and others had already advocated broad-scope practice and had taken iconoclastic positions against the purism of the Fountainhead, but it was up to Janse to rescue chiropractic procedures from fruitless quarreling over issues of inventorship, pretended superiority of this or that method. The dedication is very revealing: "To all those that have consecrated and dedicated a liberal share of their lives and fortunes to the advancement and general dissemination of science, and especially to those that have devoted such effort and substance to the dissemination of the science of chiropractic" (19). In Janse's hands, chiropractic is no longer an alternative to medical science, but rather a complementary science (even though he did discount the existence of communicable diseases, therefore rejecting the practice of vaccination).

The sections of spinal analysis, spinal adjustment, and extremity adjustment occupy 62% of the 635 page book. Janse presents both osseous and reflex procedures, the latter ranging from the spondylotherapy of Abrams to the sacral work of Hugh Logan. The emphasis on the sacroiliac area preceded by 45 years the "First Interdisciplinary World Congress on the Low Back Pain and Its Relation to the Sacroiliac Joint" (20). According to Grice and Vernon, "More than 117 procedures were presented including spinal adjustments, peripheral joint adjustments, and sinus and organ techniques. These techniques, with only slight modifications, continue to be used by the majority of chiropractors and often are referred to as 'diversified techniques' " (2).

That Janse himself most likely endorsed the term "diversified" may be inferred from his introduction to States' 1968 illustrated chiropractic technique manual: "Roentgen studies reveal that no two spines, and their relating lumbosacral and sacroiliac mechanisms, are totally alike. There are variances in the composite and mechanical dispositions, as well as in the symmetry and architecture, of the articular motor beds. These factors alone make diversification {emphasis added} of adjusting procedures imperative" (21).

States' Spinal and Pelvic Technics, in essence commissioned by Janse while States instructed at the National College, is another generally acknowledged representative work of diversified technique (18). According to Gitelman, Otto Reinert's Chiropractic Procedure and Practice (Reinert is mistakenly identified by Gitelman as "Rheinhard") (22) has also been referred to as a textbook of diversified technique. Although the various authors may not necessarily agree, the recent textbook entitled Chiropractic Technique by Bergmann et al (23) may be considered a contemporary text of diversified technique, in the sense of eclecticism, as could Stonebrink's Evaluation and Manipulative Management of Common Musculoskeletal Disorders (24).

Contemporary Diversified Technique

Some contemporary chiropractors and authors regard diversified as a named technique system, parallel to all the others, largely but certainly not exclusively identified historically with the National College of Chiropractic. From this point of view, diversified technique is sometimes seen as a corpus moves, lacking a distinct philosophical, ideological, or mechanical foundation as compared with other technique systems. Other contemporaries consider diversified technique to be immense and generic, comprising the totality of chiropractic therapeutic and diagnostic procedures that, by virtue of overwhelming acceptance, have come to comprise the core of chiropractic technique itself. In a way, the two positions are opposite sides of the same coin: as a named technique, diversified technique is too eclectic to distinctly describe, whereas as the core of chiropractic, it is too global to conveniently describe. That the great majority (91%) (25) of chiropractors themselves claim to use "Diversified" is clearly worthy of interpretation. A few representative positions are presented.

Herbert Vear, D.C., defines a "System Technique" as follows: "Following procedural directions as laid down and which follow a sequential order not necessarily related to analysis, synthesis and evaluation of the taxonomy of educational objectives" (8). Vear finds that chiropractic technique systems are "not all bad," but as such have not yet progressed through the analytic phase to synthesis and evaluation. Of course, as a chiropractic educator, he is referring less to the history of chiropractic and more to the development of the chiropractic student; but there is little doubt that chiropractic ontogeny recapitulates chiropractic phylogeny. Vear (8) situates diversified technique as antithetical to a systems approach:

"First it must be stated that neither general adjustive technique or its alternative, diversified technique, can be classified as system approaches to chiropractic practice. To be highly skilled in adjusting the many vertebral segments of the spine in as many ways as possible, in essence represents the major objective in general adjustive procedures...the application of the spinal adjustment should be preceded by an intellectual analysis of the patient's spine, pelvis, and other articulations, based upon scientific criteria."

Carl S. Cleveland, III, D.C., also views diversified technique as other than a technique system (26), even if his sense of the latter term is more historical and less theoretical than that of Vear:

"One of the first technique systems to be developed around basic principles of spinal biomechanics is the toggle recoil, meric recoil or, full-spine specific technique. This technique system, developed by D.D. Palmer and B.J. Palmer, served as an early foundation from which a variety of techniques popular in the profession have evolved. Today's typical practitioner most probably uses certain fundamentals of this system in conjunction with a variety of diversified {emphasis added} technique procedures."

Ronald Gitelman, D.C., author of a chapter entitled "Diversified Technique" in a chiropractic textbook, clearly states the diversified-as-core-of- chiropractic position (17):

"It has been said that all techniques are good and all techniques are bad. The question is, When to use which one, and on whom? This is still the credo of the practitioner who practices diversified technique, which has maintained its eclectic approach to the management of functional disorders of the locomotor apparatus...unlike the system technique approaches, diversified technique...attempts to apply the most ideal technique within the context of the reality of the clinical procedure...The incorporation of other technique systems, or of any technique, has had to pass the scrutiny of the diversified rationale, which is based on sound neurobiomechanical- orthopaedic principles."

Richard Stonebrink, D.C., author of what may be considered a textbook on diversified methods (24) insists that the term "diversified" must apply not only to the range of treatment methods, but in a larger sense to a broad interpretation of the range of tissues treated (27). Clinicians who address only one type of tissue (or even one specific bone) are correspondingly very limited in their scope of treatment procedures. By contrast, those who acknowledge a multiplicity of anatomically-related pathophysiologies would lean towards diversity in treatment methods. When asked by a chiropractic group to describe "diversified technique" procedures, Stonebrink wrote (27):

"The segmental misalignment or fixation and specific sectional adaptations are evaluated for their specific intrinsic pathophysiologies, and soft tissue and joint manipulations selected and applied than can best reduce them."

A manual on diversified technique that is used in the chiropractic college that this author attended states "Many of the moves are general, almost universal in use while others are moves that have been adapted and are used as part of other named techniques...(28).

Hinz, in his article on diversified technique methods, the Northwestern College, and John B. Wolf (29), seems to intend by the usage of the term "diversified" all of the following: emphasis on the basic sciences, educational excellence, avoidance of dogmatic debates over technique and scope of practice. According to Hinz,"...the system advocated an analysis of the patient, using the knowledge obtained through previous courses and experience, in order to utilize the technique or adjuncts which would fit the particular patient's need. This type of teaching was liberal in the sense that the school did not strictly adhere to any one technique, but studied many techniques and utilized the ones that were deemed most beneficial through deduction from the basic sciences and personal clinical experience."

David Peterson, D.C., has taken the position (18) that if diversified technique is to be considered a technique system, then:

It is a collection of adjustive procedures lacking a clear origin, definition or description...Diversified technique is a procedure searching for an identify. It does not have a clear definition, description or proponent. It lacks any protocols for differentiating and applying specific adjustments. Perhaps diversified technique is a term that has outlived any meaningful purpose and the procedures contained within it should be considered to fall within the general realm of chiropractic technique and evaluated by their individual characteristics.

Diversified: Is You Is, Or Is You Ain't, a Technique System?

Ironically, as the years went by, the body of chiropractic methodology that had originated as a liberating, eclecticizing response to the myriad of narrowly defined and often cultistic technique systems of the day found itself more than just occasionally arranged alongside of, rather than alternative to them - as yet another technique system. However paradoxically, it appears that modern diversified technique is chiefly distinguished from all of the others by its poor distinction from any one of them.

The allure of brand-name techniques shows surprising resilience, in that many contemporary practitioners seem to prefer the cookbookishness of a technique system to the clinical freedom of generic technique (30). How an individual practitioner regards diversified technique may directly reflect how he or she feels about chiropractic technique in general. Someone who prefers eclectic practice might very well endorse the descriptor "diversified" and resist any attempt to have his or her methods characterized from a systems point of view. Conversely, the type of practitioner who professes to practice "Diversified" may believe it best to specialize in a particular technique system, and object to having his or her technique defined away into the essence of all things chiropractic.

As a former New Yorker, I can state with conviction that were I to be asked "Is New York a city or a state?" I would assert that New York is both a city AND a state. Unfortunately, when asked "Is Diversified a technique system or a general adjustive technique?" I would have to answer "It is both, but prefers to be neither." Despite being almost 100 years old, "diversified" just hasn't decided what it wants to be when it grows up. Personally, the next time someone asks me what technique I use, which I usually identify as "a little bit of this and a little bit of that," I think I'll just say "Diversified...sort of."


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