q and a 2

Q and A #21-40

The following past entries are in descending order. The most recent letter is at the top.

Letter #40:
I disagree with almost everything you say on this web site. You over blow the importance of x-ray alignment, you must be obsessed with it. My unit was installed in my office ten years ago and I have never needed to check the alignment, but I know it is off because the bucky is no longer horizontal and the tube is rotated. However, I am getting people well. I have a 97% success rate and this has not changed even with a off centered x-ray unit. Why don't you guys do something constructive with your time instead of putting everything down.
DR R.__________, New York

Reply oncause to letter # 40:
Sounds like you have the touch, and if you would be willing to share your magic with the profession, maybe teach a seminar or two, I’m sure it would help all of us to put to rest any apprehensions we may have about the future of scientific "cause and effect" chiropractic.

Letter #39: (This letter responds to the reply by oncause in letter # 38)
You seem to be quite free with your opinions, even when you have very little data to judge by. Taking 3 or 4 seminars hardly qualifies you to judge the character of the presenter, let alone the professional content of the work. Your personal knowledge of the background of the Grostic-Gregory relationship is nonexistent, yet you feel free to tarnish Gregory's name. I should expect that of you perhaps, considering you waited until 10 years after Gregory's death to reinstitute your debate with him. Perhaps its easier for you if he doesn't reply.

Characterizing Gregory as the front for a personality cult is laughable, but I suppose you can say what you want on your own website. The opinion he expressed regarding instrument adjusting was very close to your own eventual debate with Gregory, and he was attempting to explain as best he could at the time, his own understanding of thedynamicsof the triceps pull as matching the actual resistance produced by the subluxation. This is a feedback response that isn't possible with any instrument I am aware of.

Dr. Gregory was being attacked by many instrument adjustors at the time and he was probably cranky on that issue. There is no doubt that he could be a difficult person. When however, you begin to malign his integrity based on very incomplete and poorly understood information and innuendo, I think you have gone too far. Upper cervical work has often had a "bunker mentality" due to its position in the profession. Honest people take data in different directions. One approach that works well doesn't invalidate all other approaches. You apparently have a successful approach although reading through your website reveals very little of any approach you might employ. You seem more satisfied to just "slander" the reputation of dead people.
Please attempt to raise the level of this discussion above these scurrilous attacks.
DR T.__________, Florida

Reply oncause to letter #39:
Dear Dr. T. Thank you for yor response.
Before we get into the gist of our discussion, I would like to take a look at your first paragraph. You state that, "Taking three or four seminars hardly qualifies you to judge the character of the presenter, let alone the professional content of the work. Your personal knowledge of the background of the Grostic-Gregory relationship is nonexistent (sic), yet you feel free to tarnish Gregory’s name."

Au contraire, Dr. T. fact is your personal knowledge of my personal knowledge of the Grostic-Gregory relationship is what is "non-existent."

Prior to attending the three or four seminars in Monroe, I attended six seminars in Ann Arbor, two of which were May classes. (The May class was termed the advanced, advanced class, to which only the field doctors who showed the highest knowledge and skill in their class work and in the X-ray work they submitted to Ann Arbor were invited.)

All seminars in Ann Arbor consisted of more than 50 hours each, with many hours of the inevitable bull-sessions added after class -- in restaurants, hotel rooms and, I confess, at times, over a beer in the local pub. (Never more than one.) This amounts, just considering classroom time in Ann Arbor, to 6x 50 = 300 hrs. Granted, Dr. Gregory was not there for all of these hours. I would guess that he was there for about half of them, which allowed me at least 150 hours in class, plus many hours of after-class, informal discussions to observe the Grostic-Gregory relationship. As B.J. would have put it, "Nuff said?"

Now, let’s get back to the "true believer-personality cult" aspect of our discussion: in our website entry that you are objecting to, there was not a word said with reference to Dr.Gregory’s character. Not a word! The critique was with regard to his professional work, most particularly with regard to the unscientific nature of some of the statements he made concerning his professional work Yet, because his professional work was questioned, you automatically responded, quite strongly, as though it were a personal attack, an attack on his "character." Is this not ipso facto the reaction of someone who is a devotee of a personality cult?

After their deaths, Sigmund Freud’s professional work can be questioned, Albert Einstein’s professional work can be questioned, B.J. Palmer’s professional work can be questioned, John Grostic’s professional work can be questioned by Ralph Gregory, but after his death, questioning Ralph Gregory’s professional work becomes unthinkable – "slander, a "personal" attack on his "character," right?

Posthumous infallibility is one of the classic symptoms of a personality cult and a very dangerous route to travel because it leads nowhere. "Cause and effect" chiropractic certainly deserves better from us.

Now, as regards Gregory's statement with reference to the "triceps pull" adjustment: if his idea was to make the force from the "triceps pull" match "the actual resistance produced by the subluxation," why did he not just say it the way you said it in your e-mail? It is not a difficult notion to get across. You stated it clearly and simply; and at the time, when in one of his classes, if he had stated the way you stated it, I would probably have accepted it.

At a NUCCA seminar conducted by Dr. Gregory, he described the force generated by the "triceps pull" adjustment in superstitious terms – "a force as yet unknown to science."

Dr. T, we believe that concepts and statements of a superstitious nature are damaging to the progress any scientific discipline, and that, considering the present very fragile state of UC chiropractic, we should distance ourselves from them.

Discussing concepts and techniques of UC practice on a logical basis is the main reason we have put our time, effort and whatever money it takes into this website; and, with this in mind, we wish to thank you for your contribution to the debate.

Letter #38: (This letter was a follow up question to letter #37)
Your response was rather politically correct - you were walking a fine line of trying not to offend anyone. I must ask you to elaborate as to what turned you off on Dr. Gregory, and NUCCA? I have heard that he was somewhat over bearing. Again, I must repeat that I am not trying to be offensive to either NUCCA or Dr. Gregory, I respect what they have done and stand for.
Dr. Z__________, California

Reply by oncause to letter #38:
My comment on this will be very simple and straightforward.

During the last class I attended in Monroe, someone asked Dr. Gregory about the possibility of building a machine to make the adjustment. It was obvious that this struck a nerve, and Dr. Gregory proceeded to state categorically that you could not correct the subluxation with an adjusting machine.

"Why not," I had the effrontery to ask.

Gregory then launched into a convoluted explanation, the gist of which was (and this is a quote), "The force that emanates from the human pisiform as a result of the triceps' pull is a force that is as yet unknown to science."

To put it simply, when someone makes a statement of that nature, they have lost all credibility and you must question everything else they say.

In my book, if UC chiropractic has a future, it cannot be governed by statements that would be more appropriately attributed to a medieval nun.

And observing the reaction of the DCs present in that class, I realized that I had traveled two thousand miles to take part in what was the beginning of a personality cult.

Letter #37:
Interesting web site. I have a question that has stuck in my craw foe a while, regarding Dr. Grostic and Dr. Gregory. It seems that with the passage of time the role that Dr. Gregory played in the development of Dr. Grostic's work has steadily increased. I understand that Dr. Gregory was one of Dr. Grostic's assistants and helped teach the classes, I did not believe that he played such a pivotal role in the development of the work. The picture painted on the NUCCA web site is that Gregory was almost a co-founder of the work. I do not mean to be disrespectful of Dr. Gregory, or of NUCCA, I used to practice it but have switched to A.O. When I was with NUCCA the annual convention seemed almost cult like. Each year DR Gregory became more and more of a deity.

Since you claim to have attended so many of Dr. Grostic's classes, could I ask you, what did you observe in the relationship between Dr. Gregory and Grostic?
Dr. Z__________, California

Reply by oncause to letter #37:
I attended 6 classes in Ann Arbor taught by Dr. Grostic. Dr. Gregory was obviously very subordinate to Grostic, and there was no doubt about who developed the technique, who understood the fundamentals of the technique, and who understood the importance of teaching the fundamentals of the technique. After Grostic’s death I attended 3 classes in Monroe taught by Dr. Gregory. Because of some of the statements made by Dr. Gregory during the third class in Monroe, I swore I would never go back to another class taught by Dr. Gregory. Does that tell you anything?

Letter #36:
I tried to practice straight UC work after graduating from __________. I won’t mention the technique, but I had financial difficulties. Eventually I began to incorporate some full spine technique ie. diversified, and now I can pay my bills. Based on my experience, I have to ask the question – Don’t you think a Dr. gives up a lot of money when he tries to conduct a strictly UC practice?
DR. B.__________, Florida

Reply by oncause to letter #36.
We have seen the situation that you describe happen repeatedly when people try to practice UC exclusively without truly understanding the Philosophy, Science and Art of UC chiropractic.
If you do not thoroughly understand the Philosophy, Science and Art of UC work, it is very difficult to make a decent living at it.

Letter #35:
Hello,
Quote from oncause, reply # 29: The fact that a computer was used in your study does not automatically wrap the cloak of science around your findings.

Rebuttal Dr. R: I did not say it automatically did, just that it does not care whether it is a pre film or post film and if the evaluator is blinded to the same there is no other method of SCIENTIFIC investigation available today, that is any MORE scientific.

Quote from oncause, reply # 29: To quote you (Dr. R.) directly, "I personally analyzed the X-rays in my investigation and did it with a computer that has no bias."

Dr. R., think about this for a moment – "I personally." "My investigation." "The computer has no bias." Granted, the computer has no bias, but the program that you used was your program (The Doc), a program that you sell to the profession.

Rebuttal Dr. R: All I simply said was that I agreed with Dr. Grostic's statement from MY OWN investigation of what he was saying as far as the average correction reduction being 40%. These were not my films that were used, but that of multiple doctors. The reason that I read the film in MY investigation of Grostic's statements (which is a different project than other research published) were because my readings using the computer were the closest to the median of all other examiners combined. (Average standard deviation of .20 degrees) This speaks both for honest and objectivity.

Concerning the research that was published using The Doc!, that was blinded research using four doctors other than myself (I did not participate in ANY of the actual reading of the film.) If you have any challenges to the research, please contact the editor. As far as this being good science. Good science is that which is examined and repeated by other researchers independently, either verifying or contradicting the results. The research that I have published in CRJ has been critically evaluated, peer reviewed and REPEATED by other researchers independently!

Quote from oncause, reply # 29: Also, you mention that, "As an UC, Grostic based doctor I would have liked to (sic) seen the average be 70-95%. It is not. I don’t think this is favorable compared to expectations.

The truth of the matter is that the actual percentage of correction that your study demonstrated is an immaterial point in the exercise. It makes no difference whether the reduction that your study demonstrated was 40%, 60% or 90%. The material point in the study is simply that you did the study. Regardless of the outcome, by merely doing the study with your own computer program, you, just coincidentally, have managed to set yourself up as an authority in the Grostic technique.

Rebuttal Dr. R: I am certified in Orthospinology and considered by most as an expert the same as any other person certified in Orthospinology. I was certified long before any publications. I believe the reality of this is that I am more curious than most, (more critical).

Quote from oncause, reply # 29: Further, by the very employment of your computer program in your study you are conferring on the program itself an implied air of legitimacy. And you also, just coincidentally, happen to be selling this computer program to the chiropractic profession to be used for Grostic analysis for whatever compensation accrues to you.

In addition, you, by merely doing this study, might, just coincidentally, have enhanced your position of authority as an instructor in Grostic/Orthospinology technique, again for whatever compensation accrues to you.

Rebuttal Dr. R: You remind me of an attorney!! If you can't attack the facts, attack the doctor personally. The research that was published established conclusions that have been reproduced and supported by other researchers. If this were a marketing ploy as you have accused ME, LIFE UNIVERSITY, AND THE CHIROPRACTIC RESEARCH JOURNAL of, I would have surely manipulated the scores to show that the computer did BETTER than reading the film using the line drawing method. In fact it made no difference in the reliability of the readings. They were both equally reliable. Now either I am the dumbest marketer in the world or the research was valid science.

Concerning, income as an instructor of the Orthospinology procedure, ALL of our time is DONATED as instructors and we are paid NOTHING. Orthospinology is non profit. That is like saying you are promoting yourself as an authority in chiropractic and you have the hidden agenda of promoting YOUR practice by this very forum that YOU have set up! Isn't that the pot calling the kettle black? I believe the question most critical readers would have is what is your "hidden" agenda of this forum?

Quote from oncause, reply # 29: I am curious, what is the reliability and/or the validity of the procedures you use?

Like virtually all other chiropractic "research" which is done to "prove" the value of some technique or the value of some product, which is sold by the originator or promoter of some technique, your "study" is your benefactor.

Rebuttal Dr. R: See above. If you can't challenge the research attack the doctor, RIGHT?

Quote from oncause, reply # 29: To put it quite simply, this is not good science! It is just more chiropractic proprietary research!

Rebuttal Dr. R: I disagree, the studies that were published are good science. They have been reproduced by other investigators and their conclusions support the previous findings. This is the scientific process at it's best. If one were going to study the measurement of atlas laterality, wouldn't they use doctors that are the most qualified in measuring atlas laterality? Oh, I know, just because they are the Grostic/ NUCCA / Orthospinology / Sweat doctors that participated in the research and it is the Grostic procedure that is being evaluated it is not good science, right? Again, I challenge you to produce, published, peer reviewed research on the procedures that YOU use and lets discuss that for a while. Most doctors reading this are intelligent enough to realize that personal attacks on a contributor to YOUR forum is nothing more than your admission that you cannot challenge the results of published research. Your ONLY recourse is to AGREE or ATTACK the contributing doctor personally.

Again, thank you for allowing me to participate in this process. It is enlightening to readers.
DR R.__________, Georgia

Reply by oncause to letter #35:
Dr. R.
If you will recall, early in our postings we pointed out the inherent, gross error in Grostic, N.U.C.C.A., Ortho etc table head-placement techniques. Vectored Adjusting, A Critique

Undaunted, you dismissed this error as being insignificant.

We then pointed out the inherent vector error that results from the differences in the lengths of hand-adjustors’ arms – the differences in the “notch-transverse-resultant.”

Undaunted again, you dismissed the error as insignificant.

We responded, proving mathematically that the error factor was indeed inherent, indeed gross and indeed significant; and that it, taken in combination with the head-placement error, can put the “final adjusting vector” off the graph.

These points are fundamental to your technique of X-raying and adjusting the U.C. area. But, undaunted, you persist in your thesis. We must ask, is this some brand new approach to scientific dialectic?

Now, let's take a look at some of the points in your most recent response:

“You remind me of an attorney!! If you can’t attack the facts, attack the doctor personally.”

If you will reread our statement, the one you are referring to above, we don’t think you will find the slightest reference to your personal, or private life. (By the way our impression is that you are a very fine doctor who is dedicated to his work.) The entire content of our statement was concerned with possible bias and/or conflict of interest in your research. This certainly could not be considered an attack of a
personal nature.

(Incidentally, your response above – “You remind me of an attorney !! If you can’t attack the facts, attack the doctor…[etc,]” is the old straw-man approach. You simply distorted and extended the content of our statement, thus building a straw man, something easy to knock over.)

Next:

To quote you: "If this were a marketing ploy as you have accused ME, LIFE UNIVERSITY, AND THE CHIROPRACTIC RESEARCH JOURNAL of, I would have surely manipulated the scores to show that the computer did BETTER than reading the film using the line drawing method."

Again, this is very, very straw-mannish.

We simply pointed out possible bias and conflict of interest in your research.

To quote you: "I am certified in Orthospinology and considered by most as an expert the same as any other person certified in Orthospinology."

As we have mentioned before John Grostic, Sr. was very clear and very adamant about the following: Grostic technique and other techniques are mutually exclusive. If you mix any technique in with Grostic work you are not practicing Grostic work.

There appears to be a contradiction here. Since you have listed yourself in The National Directory of Chiropractic as using other techniques in your practice (FS, SOT) and at the same time state that “I am certified in Orthospinology and considered by most as an expert the same as any other person certified in Orthospinology,” we must wonder: is Orthospinology a continuation of Grostic work, or has Grostic work been revised to fit some brand new Orthospinology agenda?

It would appear as though you are, at your convenience, either quoting Grostic to your own purposes, or revising Grostic to your own purposes.

This seems to us to be quite inconsistent, and regardless of what “research” you have done, “proving” this or that about latter day versions of Grostic work, we cannot see where this is at all in keeping with the principles and intent of the technique itself.

Letter #34:
Subject: Where's the beef
Why don't you stimulate all of are thinking by telling us exactly how you are adjusting and why.
Dr G.__________, Georgia

Reply by oncause to letter #34:
That wouldn’t be any fun!
We would rather serve up U.S.D.A filet mignon in bite size chunks as we have been doing. That way it makes you think – best for you and your practice.

Speaking of thinking, how about trying this exercise: go over every aspect of the technique you are currently using. Does every step make logical, scientific sense? Or, do you do some, or lots of the things you do because someone told you that they should be done that way?

This type of honest self- scrutiny of your procedure is lots of fun.
Makes the phone ring too!

Letter #33:
Hi,
I was wondering if there is any group that comes to Ontario Canada to teach any of the upper cervical work you have mentioned (particularly grostic)?

Any help or advice you can give me would be much appreciated.

Dr P.__________, Ontario

Reply by oncause to letter #33:
First off, we must congratulate you for your interest in upper cervical chiropractic. When it is done properly the results are incredible. When it is done improperly, or in conjunction with some other technique or techniques. the results are random at best – much like trying to play basketball with a football.

To put it more directly, as we have mentioned before in this website, Grostic technique and other techniques are mutually exclusive; John Grostic, Sr., the originator of the technique, was very adamant about this point. He taught most of the classes himself and used only instructors who, to the best of his knowledge, were practicing his work free of the variables that are inherent in technique pollution.

Therefore, regarding your question as to instruction in the Grostic technique, we suggest you draw your own conclusions.

Letter #32:
HELLO, I WENT THRU THE SITE, AND SEEMS TO BE INTERESTING. ARGUMENTS CAN BE MADE FOR AND AGAINST EVERYTHING ON THIS SITE, OR ANYTHING IN GENERAL, TRANSLATION : I LEARNED NOTHING.

QUESTION: WHAT DO YOU DO AT YOUR CLINIC? WHY NOT TALK ABOUT GETTING PEOPLE WELL? THERE ARE PLENTY OF SUCCESSFUL PRACTICES THAT PEOPLE RETURN TO , OR REFER THEIR FRIENDS TO, THAT DO NOT DO UPPER CERVICAL, OR CHIROPRACTIC.

SO I'M CALLING YOUR BLUFF. WHATS YOUR PHONE # SO I CAN CALL YOU.
Dr O.__________, State unknown

Reply by oncause to letter #32:
If you "learned nothing" from our website, we do not see how it would help you to give us a call and interrupt our practice.

May we suggest that you take a remedial reading course at your local community college.

Letter #31:
Dr's,
I have just discovered your site and wish to congratulate you, and to thank you for opening such a forum of discussion for Upper Cervical Chiropractors.

I do, however have a question regarding rotation on the nasium. I, of course, attempt zero rotation on every pre and post, but am not always successful. I would guess, according to what is posted here, that I should retake all films that demonstrate any rotation. My confusion comes from a fairly recent study that was done concerning rotation and u/c x-rays, the article can be found at: http://www.life-research.edu/crj/32bo.html The main point in this article was that one could have up to 1.75degrees of rotation with 25 degrees of tube tilt before any appreciable distortion was achieved. I'm not sure, but I think that 1.75 degrees is greater than 1/8 of an inch of rotation... So, which right? Where did your measurement come from and how accurate is it, are there studies to support it? I do not raise this issue simply as a point of discussion, I truly want to know...I want to do what is best for my patients, without exposing them unnecessarily to x-rays.

In anticipation of your response; Yes, my tube is perfectly aligned, my double L-frame was fabricated and installed by Leland Huffaker of American X-ray, Inc. out of Tennesee. If you are not familiar with them, Leland installs the system and aligns it with the help of a laser-alignment system which he developed. My alignment films (according to the Orthospinology text book) are perfect, all objects overlap. I try to be as honest in the analyzation of each set of films as if they belonged to my wife or my mother. In my spinal balance checks, I use the same visualization; I approach each patient as though they were the most precious person in the world to me...I'm sure that my technique needs work, but people are getting better, (and many of these people are very sick) and the word is beginning to spread. I am also sure, though, that my posts could show improvement and thus am interested in any help that I can get in this area.

Thank you, again,
Dr W.___________WA

Reply by oncause to letter #31:
Thank you for your positive comments regarding our On Cause website.
In reference to your question concerning the amount of head rotation that is permissible on the A-P film: since on its A-P axis the human skull is an elliptically shaped object and the degree of elipticalness (I don’t think there is such a word, but I’m sure you know what I mean – the deviation from roundness on the A-P plane.) varies significantly from person to person, it would be impossible to come up with some rigid exponent that would apply here. For instance there would obviously be a significant difference in rotation tolerance between a dolichocephalic skull (a skull that tends to be rounder) and a brachycephalic skull (a skull that tends to be more elongated), and all the shades of difference in between.

So there can really be no hard-fast rule.

We are assuming that you are using some type of cephlocentroscope or skull dividing instrument as in the Grostic technique, therefore you must keep in mind the following: since the skull is by far the largest object in your nasium film, and its borders are by far at the greatest distance from the hypothetical central ray and thus the most inherently prone to distortion, it is very important to minimize head rotation. This, of course, is because it is the skull line that you are establishing with your instrument, which together with your atlas plane line is your starting point for the rest of your analysis.

What you can do is to make sure that you shoot your Pre according the Major and Minor checkpoints. Keep in mind that these structures like all other structures in the human skull are subject to anomaly and asymmetry. Therefore, your acceptance of your Pre nasium can only be based on your own judgment; you have to split the difference, so to speak, of the plurality of these structures. In a given film some of these checkpoints may indicate right head rotation, some may indicate left head rotation. If that happens, you probably have a good film. If all of these checkpoints indicate left head rotation or right head rotation, re-shoot your film. If some indicate right head rotation, but more indicate left head rotation, you probably have some left head rotation.
Once you have a Pre that, to the best of your judgment, conforms to the plurality of those checkpoints, you have a starting point and the important thing then is to take your Post so that you are comparing apples to apples, not apples to oranges.

When you do have a good nasium, checking for the "orange to apple" quotient is very simple. Provided your posterior arch looks the same on both films (tube angle and placement were the same), note where the nasal septum on the Pre vertically crosses the odontoid process and where the lateral margins of the nasal cavity lay over the lateral masses on each side and, if the variation is 1/8 of an inch or less you have a reasonably reliable Post X-ray. You don’t necessarily have to use these points (the nasal septum and the lateral aspects of the nasal cavity), but they are usually the easiest to see and to measure.

This all sound very difficult, and we must say that it is not an easy thing to do, but with practice, it will become easier and easier. And you will find that you are shooting more and more accurate films, which, of course is what your patients are paying you to do.

To reiterate, we would like to clarify one point from the above: the nasal septum, as mentioned above, is in itself not a reliable checkpoint, and should not be considered as such. It should only be used as a comparison checkpoint to compare the Post to the Pre. You can pick out the nasal septum and lateral margins of the nasal cavity very easily. If they do not cross through the same structures on your Pre as they do on your Post, there is obviously a rotational difference between your Pre and Post film.

Once you have a set of Pres and Posts shot to this tolerance you have eliminated a big chunk of variables. And remember, the width of a big pencil dot can easily create enough of an error in your analysis to significantly change your laterality factor, or any other factor for that matter. So we recommend that you keep a sharp pencil and most of all, a sharp, honest eye. If you do this, you will know when you have and when you have not done the job, and you won’t find it necessary to mix other stuff into your practice.

Just one more comment, this on the philosophy of personal honesty and sincerity that you are bringing to your practice: in our opinion here at On Cause, it is a winner! Hang in there with it and you will build a very nice practice. Stay absorbed in your work – if done right, it is the most fascinating and rewarding work in the world!

Letter #30: (This is a follow up letter to oncause's reply to letter #28.)
Please clarify this question further. OK Now explain to me what you tell the patient who gives you the following history. Low back pain radiating into the right leg. There is some tingling in the same foot. Symptoms came on immediately after the patient bent over to pick up a laundry basket full of clothes.

Now I know we're going to adjust the atlas. But it wasn't an atlas
subluxation that caused the problem. So I want to know how are you going to relate this back injury and pain to the atlas on this patient.

Dr X.__________Michigan

Reply by oncause to letter #30:
The condition which you describe – the low back pain, post lifting - is, as you no doubt know, a condition which is very commonly seen in chiropractic offices.

But before we get into the neurological understanding of these cases, I am going to digress just a bit. The reason I am doing this is because, based on the poll that we took which prompted the establishing of this website, it appears as though the chiropractic profession has drifted so far off course that there seems to be somewhere between little and no understanding of how a cause and effect practice is conducted.
So, if you will bear with me, I’m sure you will see why it is necessary for me to approach your question with some prefacing remarks and statements.

First of all, with the number of patients we see in our offices, we usually care for several of these low back cases per day. These are usually established patients who have injured themselves doing some type of work which has "strained’ the lower back. These cases are no problem. We make the proper U C adjustment and expect them to be much better, if not later that day at least by the next morning. Frequently, when they are adjusted properly, they will experience relief before they leave our office.

However, although we conduct a strictly referral practice, occasionally, even though the person has been referred to us, they may come into our office with the idea that we are going to manipulate their back-bone. When this happens, our office manager consults with them, making sure that they understand our approach before we accept them as a patient. If there is the slightest indication that they do not understand the cause and effect approach, our O.M. tells them to go home and think about it. Usually this type of patient does not come back, which is what we prefer.

Now, getting back to the technical/neurological aspects of your question: in a case like this, one of two things has occurred:

1) The patient was out of adjustment (upper cervical), and since, as you know, all spinal motion is accomplished by an unfathomably complex system of pulleys and levers driven by C.N.S. signals, the system was out of phase, unbalanced and therefore very vulnerable to injury before the load was put on the spine. In a case like this, it would not take much, depending on the direction of the lifting, how far the person was off of their center of gravity and how much lower spine distortion was present to begin with, to elicit pain. Sometimes, again, as you know, this may be very severe pain with accompanying immobility.

2) The patient was not out of adjustment (upper cervical) and they simply lifted something too heavy for their musculature which resulted in a muscle strain In this case, upon examination, the patient would check clear of pressure and we would expect them to feel much better very quickly with no intervention.

Now back to case #1 (the patient with low back pain who is carrying nerve interference). Being out of adjustment caused them to be more vulnerable to injury in the first place and then, because they have remained out of adjustment the interference not only is preventing the C.N.S. from making the necessary repairs but also is actually adding to the aberrant feedback confusion within the C.N.S. and most likely adding fuel to the flames. So you have a vicious trauma loop in place.

In order for the C.N.S. to initiate repair, the C.N.S. must be able to perceive exactly what is happening on the afferent side of the loop and it must be able to transmit proper signals over the afferent side of the loop to engineer the repair process.

Fooling around locally with a condition like this at the site of the pain is at best ineffective and at worst creates more aberrant feedback that the C.N.S. has to contend with. This actually retards the healing process. But the human body is tough and extremely adaptable, and usually, over a period of time, the patient feels better in spite of the D.C.

The same principle applies to the sprained ankle situation that you described. Obviously there has been some damage done to muscles, tendons and ligaments by the trauma. However, the rate of repair is dependent on the capacity of the C.N.S. to perceive the damage and initiate a repair loop. And the C.N.S cannot be offended locally only. If there is interference in the C. N.S., the C.N.S. is affected both locally and as a unit!

As a matter of fact, we often see patients who have incurred some type of chronic, troubling injury – sprained ankle, knee, shoulder etc, but who have consulted us for some (in their mind) unrelated complaint. And it is not uncommon, when they return to the office for their post-adjustment check-up, for them to ask, "Could that adjustment you made two days ago have anything to do with my ankle (shoulder etc.)? It has been nagging me for months. I’ve been to physical therapy with very little help, but right after you adjusted me it started to feel better, and now it is much, much better."

GUESS WHAT HAPPENED!

Letter #29:
Quote from oncause, reply # 27: Having DCs analyze their own post x-rays, and then using the "pooling" of their findings to draw a conclusion does not sound like a very reliable study.

Rebuttal Dr. R: Again, I don't know how to say it any more simple... that was not what was done! I personally analyzed the x-rays in my investigation and did it with a computer that has no bias. I did not know whether they were pre or post films. This is a very reliable way to do it. The only conclusion one can draw is that the measurement of atlas laterality changed by 40 - 45% and it changed in a direction towards orthogonal.

Quote from oncause, reply # 27: First of all, that is not even a single blind study.

Reply Dr R. Not true!

Quote from oncause, reply # 27: Even in studies done by scientists trained in how to conduct studies (i.e., eliminate variables that might skew the results), the scientists tend to find what they are looking for (i.e., what suits their purposes).

Rebuttal Dr. R: Agreed.

Quote from oncause, reply # 27: Not only were the studies that you described not controlled, they were done by people who had a vested interest -- professional ego, which at times was melded with a proprietary interest -- in producing data which was favorable to their purposes.

Reply Dr R. I don't know about you, but as an UC Grostic based doctor I would have liked to seen the average be 70 - 95%. It is not. I don't think this is a favorable outcome compared to expectations. I have no proprietary interest in the outcome, I make no additional money or any less due to this outcome. As far as professional ego, this is a blow to most UC doctors ego I would expect. Research published in CRJ in 1994 addresses the reliability of the line drawing procedure, maybe you should review it.

Quote from oncause, reply # 27: You don't have to be Sherlock Holmes to realize that the slightest variation in the way films are shot (i.e., 1) nasium: head-rotation, low or high arch, fuzzy film; 2) vertex: head tip and/or fuzzy film -- to name only a few) can cause major error in analysis.

Rebuttal Dr. R: There is no doubt that films with poor placement could affect your measurements. The question is then do trained UC doctors take films with a high enough degree of consistency to use for the measurement of atlas laterality. These things were addressed in more published research in CRJ in 1998. If you have challenges to the research, then you may want to write the journal. Patient position was analyzed via computer assisted modeling. Changes in the measuring process compared to changes in how the simulated patient altered positions relative to the film were studied. The conclusion was that patient positional changes did not have a significant affect on the measure of atlas laterality. (in clinical practice) Sherlock Holmes would have done a little more investigation than apparently you have.

Quote from oncause, reply # 27: Put this together with skull-divider error, line-drawing and measurement error -- all pushing toward "favorable interpretation" -- and you have a bowl of spaghetti that can be arranged any way you like. And this is just for starters.

Rebuttal Dr. R: Critical thinking is a good thing, however what you show here is your opinion that is contrary to published studies. You are entitled to your opinion.

Quote from oncause, reply # 27: To put it more directly, Dr. R -- to base any conclusions on a bunch of DCs sending in their own pre- and post- adjusting statistics ain't real good science. It's more like a very short step above hearsay.

Rebuttal Dr. R: I would agree with your statement above, but that was not what was done in the referenced study.

Quote from oncause, reply # 27: Our purposes for asking questions regarding John D. Grostic, D. C., are simple: What were his qualifications? How much practical, hands on instruction and experience did he have in his father's work?

Rebuttal Dr. R: I am sure that you are aware of John D. Grostic, D.C.'s qualifications, if not, you can read a paper written by Edward Owens, D.C. concerning Dr. Grostic's accomplishments. I believe it was published as an editorial or forward in the CRJ in the late 1990s. They are too numerous to list here.

Again, thank you for allowing me to participate. I am sure that your readers will benefit from this critical thinking/discussion process.

Dr R. __________, Georgia

Reply by oncause to letter #29:
Thank you for your response.
The fact that a computer was used in your study does not automatically wrap the cloak of science around your findings.

To quote you directly, "I personally analyzed the X-rays in my investigation and did it with a computer that has no bias."

Dr. R., think about this for a moment – "I personally." "My investigation." "The computer has no bias." Granted, the computer has no bias, but the program that you used was your program (The Doc), a program that you sell to the profession.

Also, you mention that, "As an UC, Grostic based doctor I would have liked to (sic) seen the average be 70-95%. It is not. I don’t think this is favorable compared to expectations."

The truth of the matter is that the actual percentage of correction that your study demonstrated is an immaterial point in the exercise. It makes no difference whether the reduction that your study demonstrated was 40%, 60% or 90%. The material point in the study is simply that you did the study. Regardless of the outcome, by merely doing the study with your own computer program, you, just coincidentally, have managed to set yourself up as an authority in the Grostic technique. Further, by the very employment of your computer program in your study you are conferring on the program itself an implied air of legitimacy. And you also, just coincidentally, happen to be selling this computer program to the chiropractic profession to be used for Grostic analysis for whatever compensation accrues to you.

In addition, you, by merely doing this study, might, just coincidentally, have enhanced your position of authority as an instructor in Grostic/Orthospinology technique, again for whatever compensation accrues to you.

Like virtually all other chiropractic "research" which is done to "prove" the value of some technique or the value of some product, which is sold by the originator or promoter of some technique, your "study" is your benefactor.

To put it quite simply, this is not good science! It is just more chiropractic proprietary research!

Letter #28:
OK. Now explain to me what you tell the patient who gives you the following history. Low back pain radiating into the right leg. There is some tingling in the same foot. Symptoms came on immediately after the patient bent over to pick up a laundry basket full of clothes.

Now I know we're going to adjust the atlas. But it wasn't an atlas
subluxation that caused the problem. So I want to know how are you going to relate this back injury and pain to the atlas on this patient.

Thanks
Dr X.__________Michigan
Reply by oncause to letter #28:
We need to know how you arrived at the conclusion that "it wasn't an atlas subluxation that caused the problem."

Letter #27:
Thank you for posting my letter and your response. I know that all will benefit in some way from our questions and explanations.

Quote from oncause, reply # 24: Having attended six seminars in Ann Arbor, taught by John Grostic, Sr., I never heard the 40% - 45%, or any other percentage figure mentioned regarding the first, second or any other thrust. I would like to know how John Grostic, Jr., came up with the 40% to 45% figure. How much hand adjusting did he do? For that matter where was his practice and how big was it? Have you seen the design of his research study? Or, is this just more pure assertion and hearsay that you may have absorbed and then added your own adjectives, (i.e., immensely,) to give it weight? Is this something you heard somewhere, or read somewhere, in some "peer reviewed scientific" chiropractic article? Would not John Grostic, Jr. had to have been a superb hand adjustor to have done valid research -- the type of hair splitting research that would yield the 40% to 45% conclusion? As you no doubt know, it takes years and years to develop an accurate Grostic hand adjustment and one must be extremely flexible, and have a very svelte figure. Need we say more?

Rebuttal Dr. R: You ask very good questions. I can not answer for John D. Grostic, D.C. and as you know, unfortunately, he is no longer with us. I can only say that it is my understanding that these numbers came from a pooling of many doctor's pre's and post x-rays as well as Life's student clinic, research dept. patients, and unpublished studies that were done (I have seen with my own eyes a few of these). These would be averaged mathematically and the 40 - 45% reduction is refering to atlas laterality alone and the range is because of a few diffent studies with various averages between 40 and 45%. I have been in the unique position of having access to computer assisted x-ray digitization, that stores x-ray listings. I have looked at several doctors corrections on multiple cases along with my own. (some doctors had very large practices and some average practices) Based on mathematical averaging, I would have to agree with John D. Grostic, D.C.'s statement (to me on various phone conversations). I have not published these findings, nor do I think John D. Grostic, D.C. published his findings. Remember, these are the first post x-rays ( in my studies and I believe, John D. Grostic's also), most UC chiropractors had second, third and fourth post films taken at various times (that I looked at). I did not study (mathematically average) the last Post film compared to the Pre film. I would suspect that average correction would be much higher then. If, and Where, John D. Grostic, D.C. practiced, how big was his practice, or how much hand adjusting he did are insignificant questions. I am curious as to your purpose for asking those questions.

Dr R. __________, Georgia

Reply by oncause to letter #27:
Having DCs analyze their own post x-rays, and then using the "pooling" of their findings to draw a conclusion does not sound like a very reliable study.

First of all, that is not even a single blind study.

Even in studies done by scientists trained in how to conduct studies (i.e., eliminate variables that might skew the results), the scientists tend to find what they are looking for (i.e., what suits their purposes).
Not only were the studies that you described not controlled, they were done by people who had a vested interest -- professional ego, which at times was melded with a proprietary interest -- in producing data which was favorable to their purposes.

You don't have to be Sherlock Holmes to realize that the slightest variation in the way films are shot (i.e., 1) nasium: head-rotation, low or high arch, fuzzy film; 2) vertex: head tip and/or fuzzy film -- to name only a few) can cause major error in analysis.

Put this together with skull-divider error, line-drawing and measurement error -- all pushing toward "favorable inteerpretation" -- and you have a bowl of spaghetti that can be arranged any way you like. And this is just for starters.

To put it more directly, Dr. R -- to base any conclusions on a bunch of DCs sending in their own pre- and post- adjusting statistics ain't real good science. It's more like a very short step above hearsay.

Our purposes for asking questions regarding John D. Grostic, D. C., are simple: What were his qualifications? How much practical, hands on instruction and experience did he have in his father's work?

Letter #26:
Dear Sirs,
Not even a G5? Sure, we'd all like to be pure. But I guess the reason we use an activator on the hip or some traction is because we just get tired of trying to fight the patient. Or trying to explain why we don't adjust them when they're having the worst symptom day of their life. "I'm sorry Mrs. Jones. Your legs are even, the scanning is clear and you have a straight line (hopefully not the effects of some pain pills they've put in their system 3 hours before). Go home, lie down; You'll feel better in the morning."

Then we wonder why the patient doesn't come back.
I for one know that education is the key. So obviously you folks must have education down to an exact science. And I hope you would be willing to share it.

1.) How do you determine when and when not to adjust?
2.) Do you place patients on a care plan?
3.) Do you give a patient orientation/lecture? If so, can I get a transcript of it?
4.)What do you tell them in the x-ray report?
5.) What charts do you use?

You see, I am an AO chiropractor. But I would like to improve both my results and my communication skills, especially pertaining to upper cervical care. We are primarily a referral based practice (at least 80%), but I want to help more people.

So if you can answer these questions, it would be of great benefit.

And you can put my letter online; just don't put my name.

Thanks
Dr X.__________Michigan

Reply by oncause to letter #26:
Thank you for your intelligent and well-stated e-mail questions. We use a very careful and properly applied spinal balance test (leg check) exclusively in our practice. As we have mentioned previously, the SBT, in itself, can be a very exact method of determining the "when" factor. However, in applying the SBT there are many, many ways of getting the wrong answer, and that is its weakness. The highly subjective nature of this test only compounds this weakness: when a DC sees that the legs are even, or that there is a deferential, the DC is actually seeing it, and it is real in his mind, regardless of how inaccurate his actual setup is. Therefore, if the DC has not been thoroughly schooled in the fundamentals, he or she is continually checking patients in adjustment when they are out, and out of adjustment when they are in. This inevitably leads to a loss of confidence in his or her work, i.e., "The patient was checking clear, but the patient was in a lot of pain, so I had to go down there and get L4, and they felt better."

No doubt the patient could utter the words "I feel better" after an L4 adjustment. And possibly they did feel better.

But now, look at the confusion in the DC's mind: the DC has lost confidence in his or her UC work, because even though the DC saw the legs even, the DC's setup was wrong, and what the DC saw was wrong. Further, the DC has allowed the patient to influence the DC to do something based on the patient's report of the symptoms (which is in itself inherently unreliable.) So now the patient is in control, and the patient realizes it. Why would the patient want to continue with a doctor who is not in control of their health care?
The patient was lost and the practice was diminished because of a lack of knowledge of the FUNDAMENTALS.
FUNDAMENTALS are always a bore, but could you imagine a pilot flying a plane without knowledge of the FUNDAMENTALS? Or, someone playing golf without knowledge of the FUNDAMENTALS? Or, playing baseball without knowledge of the FUNDAMENTALS? Maybe in the Church league or the Beer league. But that's what the minor leagues and instructional leagues are about, aren't they?

It may be a good idea for any DC attempting to do UC work to ask himself or herself how much reliable instruction they were given in the FUNDAMENTALS. Or was the DC just given a set of golf clubs and turned loose on the golf course. "Try to get this little white ball in that hole way over there. You'll do fine. Oh, by the way, you owe me for the clubs."

Now, is it a big mystery why there is so much confusion in chiropractic? Why it has drifted so far away from the art and science of specifically locating and removing nerve interference?

Without the sound FUNDAMENTAL knowledge of when to adjust, the DC at an extreme disadvantage when the DC walks into the room to see the patient. So what does the DC do? The DC does something on every office call. Now, let's figure out more things to do, right? And we'll get paid more, right? (Maybe short-term -- but over the long haul, not close.) Where does it go from there? Let's forget about removing nerve interference altogether and do as much as the law allows. Now you have a half-baked DC trying to be a half-baked MD.
This has been a long answer to a short question. But the short question (i.e., the when factor) is an extremely important one, and we could go on for pages about this point.

If you would like to discuss this particular point further, please let us know and we will do what we can to help.

We will address the rest of your questions within the next week or two, as time permits.

Dr. X (3-31-00)
To continue answering your questions:
Question #2 -- Do you place patients on a care plan?
No.

Question #3 -- Do you give a patient-orientation lecture? If so, can I get a transcript of it?
No, we do not give patient-orientation lectures.

Question #4 -- What do you tell them in the X-ray report?
We do not do an X-ray report. On the second visit, before their first adjustment, using an occiput/atlas/axis model, we explain to the patient that they are carrying interference in the UC area, and that, that in our opinion, is what is most likely causing their problems -- and that that is what we are going to correct.

Question #5 -- What charts do you use?
We use the old BJ generator chart and at times the safety pin cycle. Even though this is an antique, and an oversimplification, we find that it works well. However, you must keep in mind that charts play only a small part. They do not educate the patient; you do, step-by-step, as you care for them.

Letter #25:
Just discovered your site. Keep up the good work!

Blair's major contribution was his custom x-ray technique which captures the articulations between atlas and occiput. I was adjusted for years on the right by chiropractors who assumed symmetry between the two articulations, with poor results. Blair x-rays revealed a left posterior inferior misalignment. Now I rarely need to get adjusted. What does the instrument measure? As one who has used dozens of single and double probe instruments, including BJ Palmer's timpograph, "It doesn't matter!" Nerves and blood vessels travel together. You are measuring both. It's the PATTERN of subluxation that matters. It is easy to determine when someone is "stuck." I also rely on Prill leg checks to decide when to adjust, and if atlas or axis is the major problem. Finally, have you ever noticed how with a C1 subluxation the leg moves straight down and back when patient turns head, where as, foot also moves a little bit laterally and back with a C2 subluxation?
Dr B.__________Michigan

Reply by oncause to letter #25:
Thank you for your e-mail and your information on Blair work. Regarding "heat" measuring instruments: having graduated from Palmer at the height of the HIO era, I am familiar with "pattern work." You mentioned having used "dozens of single and dual probe instruments, including B. J. Palmer's timpograph."

Just as a matter of historical interest, the three major instruments that were used at Palmer to determine the "when" factor were the following:

1) The neurocalometer (NCM) -- a hand-held, double-probe instrument that simply had a dial with a needle, which swung as it was glided up the neck from V.P. to the inferior nuchal line. (The DC would then draw the pattern from memory.)

2) The neurocalograph (NCG) did the same thing -- measured the heat differential with a double-probe instrument; but, in the case of the NCG, the thermocouple differential (from one side to the other) was scribed with a stylus and the NCG produced a tracing of the differential "pattern." The NCM and the NCG did essentially the same thing, the difference being that the NCG produced a written graph of the "pattern."

3) The chirometer was the third heat-detecting instrument that was used (but to a much lesser extent.) The chirometer was a single probe instrument used to measure heat on the skin over the atlas transverse processes.

You also mentioned "BJ's timpograph." I don't know of an instrument in BJ's repertoire called the timpograph. He did have an instrument called the "Timpometer," which was a gliding machine (a more generic term was "Constant Glide) that, by means of a vertical worm gear, glided the NCG probes at a "constant speed," thus producing a reading which was more time constant.

Do we use heat-measuring or recording instruments in our practice? No.

Regarding the variation in the behavior of the leg differential: No, we have not seen this. And while it may be true, we think that this kind of observation could be very subjective -- and thus, very misleading.
Thanks again! If you have any more questions or comments -- Shoot!

The more we immerse ourselves in our work, the more fun it becomes, and strangely enough, the more the phone rings.

Letter #24:
Hello Doctors:

Thank you for allowing me to participate in your discussion.

You said, in Vectored Adjusting: A Critique

Point #1:

Quote from Vectored Adjusting: It is virtually impossible for the human body to deliver a rectilinear (straight line) force; therefore, it is an inefficient adjusting machine. To illustrate this I used the analogy of a person attempting to play pool by
using a pisiform contact on the pool ball with the arms as the driving
force.

Rebuttal Dr. R: What is your point? Of course it is difficult to provide a rectilinear force with the human body, SO WHAT. It is well known that the hand adjustment is not a perfect vectored adjustment anyway. In fact it is a multivectored adjustment at best. What we strive for is to initiate the correction down a hypothetical vector. It is theorized, based on basic physics, that the vector is the best line of drive to BEGIN the correction. In reality a dynamic, mutlivectored angular or circulinear adjustment would be required for the most efficient adjusment. If the body was a perfect machine and the Grostic model was the perfect model then you would only need one thrust to achieve 100% correction of the described misalignment. John D. Grostic, D.C. studied this immensely, and stated that the AVERAGE correction on the first adjustment/thrust was 40 - 45%. When you compare the reliability of Grostic based adjuster (all of your points concidered) to other forms of adjusting, they shine like a new pennies! I believe HIO operates on the assumption of a misalignment of C1, what is this technique's average correction. Heck, for that matter, what is the average degree of misalignment? How reliable is that system of adjustment? Grostic based procedures are a least attempting to define and MEASURE these things. I don't understand what you're argument is trying to accomplish other than mental exercise.

Quote from Vectored Adjusting: When the head is placed on the headpiece preparatory to adjusting, a slight turning of the skull in either the rotation or the laterality plane, or both, will cause the position or attitude of the atlas to change significantly with reference to the vector, or line of drive, which has been calculated. (The bulk of my article, "Vectored Adjusting..." was devoted to this last point.
For further elaboration of the rectilinear vs. Curvilinear issue see "The
Physics of the Upper Cervical Adjustive thrust" [Chiropractic Economics
July/August 1980 issue] )

You Continue:

Quote from Vectored Adjusting: When NUCCRA discusses point number 2 -- the issue of headpiece placement, and whether a slight turning of the head on the headpiece in the rotation or laterality plane will result in a significant error -- they make statements and quote a numberr of referenced sources all dealing with the mechanics of motion in the cervical spine. None of this is Germane to the argument.

The point which is made in my article "Vectored Adjusting: A Critique" was very simple; i.e., when the head turns on the headpiece the atlas moves with it, therefore a slight turning of the head causes the attitude-or position of the atlas to change with respect to the calculated vector. This turning then results in an enormous error, and this error is inherent in all vectored adjusting procedures. The following is a direct quotation from my article: "The average human skull is about 22 inches in circumference. (The skull is obviously not round in shape. It would best be described as being elliptical, with the long axis being A-P. However, when it rotates it follows a roughly circular path.) As a result, each inch of circumference represents approximately 16 degrees.

360/22 = 16.3

Since each inch contains slightly more than 16 degrees, each 1/16 of an inch equals approximately one degree. A change in the position of the skull of 1/16 of an inch will cause a corresponding one degree change in the position of the atlas"

Rebuttal Dr. R: Penny wise and pound foulish. Again, SO WHAT. You describe the a rotation about the odontoid of C1 of maybe 1 degree (1/16 in. error could be a little on the high side but we will use it for argument sake). Big deal. Obviously, you nor the NUCCRA has thought much about how and WHY the theoretic vector was derived. When measuring to line up for the hand adjustment we measure for the rotational component of C1 by measuring 1" for every 1 degree of C1 rotation about the Y axis. Yet, 1 inch is really equal to only .42 degrees of C1 rotation about the Y axis. The reason this is done is to insure that one is on a line of drive near but outside of the absolute minimum vector required to initiate the desired movement of C1. Using your analogy, 1/16 inch of skull movement meaning a 1 degree change in C1 position is still "within tolerance" of the designed vector. The average misalignment in rotation about a vertical axis for C1 is around 2.5 degrees. This means we measure 2.5 inches anterior or posterior to line up for the adjusment. 2.5 inches is = to 5.9 degrees of rotation of the Vector about the same vertical axis. We are lined up near, but outside of the C1 rotation by more than a couple of degrees. If the head moves 1 degree, BIG DEAL! We still are lined up in a fashion to initiate the desired direction of correction. (2.5 misalignment + 1 deg. error = 3.5 deg. We are lined up at 5.9 degrees) I am sure you remember Dr. J. F. Grostic stating "tolerance is to the high side". This is what he meant. The model is designed so as to handle small errors in head placement as you have described for the MAJORITY of the cases. I estimate that the error that you have described could be a problem in up to a MAXIMUM of 30% of the cases (in reality it is near 15%). That means that the model will be usably accurate for 70% plus, of the cases. These are very good percentages when considering the huge number of possible misalignment that are being handled by this model. If you know a better, more accurate method I am all ears.

Dr R. __________, Georgia

Reply by oncause to letter #24:
Yes, Dr. R., we agree. The Grostic hand adjustment, if for no other reason that that it tends to have more rectilinearity, is far superior to the toggle recoil of HIO etc.
Having attended six seminars in Ann Arbor, taught by John Grostic, Sr., I never heard the 40% - 45%, or any other percentage figure mentioned regarding the first, second or any other thrust. I would like to know how John Grostic, Jr., came up with the 40% to 45% figure. How much hand adjusting did he do? For that matter where was his practice and how big was it? Have you seen the design of his research study? Or, is this just more pure assertion and hearsay that you may have absorbed and then added your own adjectives, (i.e., immensely,) to give it weight? Is this something you heard somewhere, or read somewhere, in some "peer reviewed scientific" chiropractic article? Would not John Grostic, Jr. had to have been a superb hand adjustor to have done valid research -- the type of hair splitting research that would yield the 40% to 45% conclusion? As you no doubt know, it takes years and years to develop an accurate Grostic hand adjustment and one must be extremely flexible, and have a very svelte figure. Need we say more?

Letter #23:
I am in my last year of school and I want to ask you about DR Sweat. I have taken his classes and even seen his clinic. I am planning on practicing A.O. and I am currently finding financing to buy the adjusting instrument. I read his article published in the AUCCO and I was somewhat confused. (I have included it as a download in case you have not seen it.- to read it click here) I do not know what he was talking about. The letter was totally incoherent. Didn't DR Sweat learn and teach Grostic work. In the article he is almost endorsing low back work. Is this not inconsistent with what DR Grostic taught? Any information will be appreciated.

Student D_________, Georgia

Reply by oncause to letter #23:
Yes! We saw the article written by DR. Sweat and we were more than "somewhat" confused. All five doctors on our staff have read it. We have tried to give him the benefit of the doubt, but we are just as confused as you are about its content. Unfortunately the article made all of us lose some respect for what we thought was a straight "on cause" practitioner. We hope he gets it together.

I would recommend that you keep learning all you can. Stay on the fundamentals, that's the best way to keep from being confused.

Letter #22:
I saw your advertisement in the Palmer Beacon and I was intrigued by the web site. I must admit that you have challenged some of the core beliefs that I thought were "accepted" by all upper cervical practitioners. I have asked some of the faculty about this web site and they are not too complimentary and they just tell me to get to the next seminar they are teaching and all the questions will be answered. I am confused. This profession, as I get farther into it, and past the point of no return, I find that it is totally screwed up. And we as students are the ones getting screwed. I will graduate with 100k in student loan debt and I do not see how I can pay it off. I understand why there are so many unethical chiropractors out their milking the system.

Student L__________, Iowa

Reply by oncause to letter #22:
Enlightening letter. We certainly are not doing this to make friends. Occasionally we X-ray suspicious packages from chiropractors in Montana before opening them. What I will say is that the instructors obviously have a financial and professional stake in what they teach, and that has to be taken into consideration. We do not! This web site brings us no income. We are doing this strictly for the benefit of the UC community, trying to encourage, sometimes kick, them into improving themselves and possibly being more professionally and financially successful.

You can make it even with the large amount of student loan debt, but you will have to stay on principle and practice your work with honesty both to the patient and to yourself.

Letter #21:
This web site really pisses me off. In the words of Rodney King "Can't we all just get along". Come on guys you are not playing fair. When I read your site I did not learn anything, all it talks about is negative things of how I have to work on the basic stuff. Well I learned my x-ray alignment, film analysis and my leg check during my 8th trimester. I have it mastered. Why don't you talk about something valuable instead of this beginner crap. For instance, of course I know how to place someone's head on a head piece before I adjust them, it is not that difficult. Your whole rotation concept is totally overblown. I can see that the patient is not rotated. I hope you can contribute something to my future.

Student M__________, Iowa

Reply by oncause to letter #21:
Well it sounds like you know it all. In fact, I predict that you will go out into practice with the intention of practicing UC work and within a year you will be mixing in everything under the sun. Within three years you will have defaulted on your loans and either be on the lecture circuit as a so called expert or teaching at a chiropractic school. Unfortunately you will be teaching the students everything that you did wrong - everything that prevented you from building a successful practice.

We hope we are incorrect in foretelling your future but you will have to change your attitude. You do not know everything. With the doctors in our practice, we have combined over 90 years of practicing experience and we are still learning. We still spend a lot of time drilling on the fundamentals.

Add this to the inherent table placement error and you do have a rather large "cushion".

I wish to thank you for your comments, Dr. R. They did stimulate thought. However, I think we have very differing opinions on just what causes confusion. In my opinion, it is a failure to grasp and employ fundamentals. As I have mentioned previously, when you fail to grasp fundamentals everything from that point on is subject to misconception and confusion.

I may be wrong on this. But you will have to admit that something has happened to U.C. cause-and-effect chiropractic. It is fading below the horizon. As I said in one of my previous entries, there is a steady, inexorable decline, and this decline seems to be very much a decline in the economics of upper cervical practice. DC’s simply do not know enough about the fundamentals to earn a decent living at their work.
Maybe fundamentals are not as important as I have portrayed them to be. But I would arm wrestle you a long time on this issue. It has been my experience that attention to fundamentals builds skills, skills build results and results build a lively, thriving practice.

We welcome any further comments you may have. We would be happy to discuss with you the fundamental reasons for not mixing full spine technics in with "Grostic" work. We would also be happy to discuss the downside effect that the mixing of full spine technics with Grostic work has on referral activity.