The Structural Care Model vs. The Biochemical Care Model
By Eric Huntington, DC
In attempting to try and categorize the different methods of chiropractic practice, certainly one of the major differentiating factors would be those practicing in a structural (or musculoskeletal) care model and those using more of a biochemical care model.
The musculoskeletal doctors would include anyone primarily using adjustments, manipulation, PT, exercise, massage, etc as the main treatment intervention. In the biochemical category we would find those primarily providing treatment using supplements, dietary advice, detox protocols, weight loss, and possibly drugs—although for this article, I am not going to include drug therapy as part of that category because it represents so few chiropractic practices.
So, which method of care is superior?
Or maybe the questions should be, "which method of care is more appropriate for a chiropractor to deliver"? Maybe practices should consider offering a little bit of both? How do we even go about answering such questions? Well, let's take a look!
The Structural Care Model certainly seems to be at the root of traditional chiropractic. The story of D.D. Palmer's first adjustment was certainly one of a structural intervention. And if we look at B.J.'s development of chiropractic we see definite focus on spinal/structural care but there are enough mentions of nutrition in his writings to know that B.J. appreciated the role of proper biochemistry in human health.
Chiropractic also has a long tradition of nutrition as a modality. There were very significant developments in the field of nutrition made by chiropractors. This is a significant part of our history.
I am by no means an expert on chiropractic philosophy, however, I feel well versed enough in basic chiropractic philosophy, chiropractic history and practice to engage in a discussion of it. I think that any chiropractor could agree that structural care can have a profound effect on overall health, and influence biochemical indicators of health such as blood chemistry.
Also, an understanding of neurology or, simply the "safety pin cycle" would lead one to conclude that biochemical factors within the body can lead to structural problems such as subluxation. Into this latter idea would fall the aspect of chiropractic philosophy which suggests that trauma, toxins, and auto-suggestion are the root cause of subluxation. With these factors in mind, there seems to be an intimate relationship between the application of either structural or biochemical care with musculoskeletal health and proper body biochemistry.
In simple terms, it seems that the innate intelligence of the body could have a difficult, or maybe impossible task of healing the body, if the biochemistry of the body is too far gone. I believe that this would fall into the "limitation of matter" clause of chiropractic philosophy. And, of course, it would apply in reverse—a body with perfect biochemistry could cease to function or, at least function properly, with a severe enough subluxation of the spine.
So, that leads us to the question of whether or not it is the job of the chiropractor to help a patient handle his "limitation of matter" through a biochemical intervention, such as nutrition. There seems to be two logical answers to this question which lead us into the legal and ethical sections of this discussion.
Philosophically: SLIGHT ADVANTAGE STRUCTURAL BASED PRACTICE
(I say slight only because we are chiropractors. There is certainly nothing philosophically wrong with a nutrition bases practice)
A chiropractor can offer any type of care which falls under his scope of practice. So there is not advantage either way with regard to the law.
However, some practices that are providing biochemical care are also accused of practicing medicine without a license. I'm not suggesting that they are in fact practicing medicine without a license. But this type of practice has more exposure to problems with the medical board and chiropractic board, just by the very nature of what they offer, in terms of care. Therefore, it is very important to really know your laws, and what you are doing if you choose to practice in this manner.
Legal: ADVANTAGE STRUCTURAL PRACTICE
Second, if the chiropractor becomes aware of a condition which adversely effects the patient, or limits the effectiveness of the structural care he is providing the patient, the chiropractor should inform the patient and either provide a solution, or guidance—or referral to someone or someplace who can provide a solution.
So, can a chiropractor provide biochemical care, such as nutrition? Well, he sure can as long as what he offers is in accordance with his scope of practice.
Should a chiropractor provide care with an emphasis on a biochemical model or structural model—well, it's up to him, as long as he's following the law. That leads us to the question of, "Which is better?"
Well, since I can imagine a patient encounter where either structural care or a biochemical intervention would be more appropriate and more helpful to the patient, I guess I'd have to say that it depends on the patient and the situation. I guess we could surmise that from the patient's perspective, a chiropractor who offers both types of care would be ideal.
This would allow the chiropractor to use whichever treatment protocol best matched the patient's condition or situation. In many cases, I can imagine that both would be appropriate for an individual patient.