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Chiropractic in Britain

After its formative years in America (outlined in the previous article), chiropractic soon spread outside the USA and, following the setting up of a body in 1947 to regulate and monitor the standards of chiropractic education in America, others were formed in Canada, Australasia and Europe.

The British Chiropractic Association (BCA) was formed in 1925 and in conjunction with all the European chiropractic associations opened the first recognised chiropractic college outside North America in 1965. This is the Anglo-European College of Chiropractic (AECC) in Bournemouth. All BCA members practise under a code of ethics and rules set down by the Association.

In 1972 the McTimoney Chiropractic College (then School) was founded by John McTimoney who was trained by Dr Mary Walker DC, a graduate of Palmer College. The McTimoney Chiropractic Association (MCA) governs the code of ethics and professional conduct of those practitioners trained at the McTimoney Chiropractic College based in Abingdon.

The Oxford College of Chiropractic (previously the Witney School) formed in 1984 teaches a similar whole body approach, although there are some differences in technique. The professional body for these practitioners is the British Association for Applied Chiropractic.

There is also a Scottish Chiropractors Association, members of whom are trained at the AECC.

All chiropractic groups were represented on the Chiropractic Registration Steering Group which has been guiding the profession towards registration, and in 1994 the Chiropractors Act received Royal Assent. In January 1997 the first ever General Chiropractic Council was formed consisting of both chiropractors and members of the public. This body will be responsible for the regulation, development and promotion of the whole profession and the establishment and maintenance of a statutory register. The GCC will ensure that only those suitably qualified will be able to practise as a chiropractor.

The first chiropractic treatment, then, was given in 1895. In 1896 Palmer was jailed for practising without a medical licence (and probably adjusted spines whilst in prison!). One hundred years later, chiropractic is now legally recognised whilst the Clinical Standards Advisory Group1 and Royal College of General Practitioners2 recommend that GPs should send appropriate low back pain patients to chiropractors, osteopaths and physiotherapists.

Development of McTimoney Chiropractic

In 1939 John McTimoney had a bad fall from a ladder and in 1942 began losing the use of his arms as a result. Medically, the only option was an operation with poor prospects of recovery. Previously, his wife had been cured of catarrhal deafness by a chiropractor, so McTimoney went to him for treatment and was also cured. He became fascinated with the logic of the chiropractic philosophy of cause and effect and eager to learn about it himself. However, at that time the only training available was in America.

In Oxford, where he lived, the chiropractor was Dr Mary Walker, who had trained at the Palmer College under B. J. Palmer, the son of D. D. Palmer. Despite the college ruling of graduates not being allowed to teach outside the college, she had wanted to pass on her skills and undertook to train him herself with two other chiropractors as his examiners. He described his training as comprehensive and severe, and it took three years.

In 1951 he started to practise in Banbury, evolving and developing one particular technique – the toggle torque recoil – an adaptation of a Palmer College atlas adjustment. Using engineering principles and looking at the anatomy of the skeleton, deciding on the correlation between the bony misalignment he palpated and the type of adjustment needed to correct it, he developed his technique into that which is taught today at the McTimoney Chiropractic College. He was a great innovator and chiropractic was his passion.

"Mac" as he was affectionately known, went on to develop his whole body approach to the treatment of animals, particularly horses and dogs.

After twenty years in practice his patients were determined that Mac's unique treatment and technique should not disappear with its developer. In 1972 he opened the Oxfordshire School of Chiropractic to mature students and in 1980, aged 66, died of a heart attack brought on by overwork. His students, wishing to continue his work, with Mrs McTimoney's agreement, took over the School and renamed it the McTimoney Chiropractic School in memory of him.

What is McTimoney Chiropractic?

This particular set of chiropractic techniques seems to the observer (and usually receiver) to be extremely light and almost incapable of producing any effect whatsoever. The key to the success of the adjustments, however, is the speed with which they are delivered.

The McTimoney chiropractor's specialism is a type of swift thrust known as the "toggle torque recoil" technique (see Figure 1). This technique was introduced by B. J. Palmer (D. D.'s son) and is used to some degree by most other chiropractors but not to the extent to which McTimoney chiropractors use it. To perform the toggle torque recoil, the practitioner uses one hand as a "hammer" and the other as a "nail". In effect, the hammer pushes and torques the nail in the desired direction with one extremely swift, painless movement, with almost instantaneous recoil. This effectively frees the joint and eases the tension in the surrounding muscles.

Figure 1 Toggle Torque Recoil adjustment

The positioning of the skeletal system of the body is analysed as a whole at each treatment, particularly the atlas and sacro-iliac joints. The foundation to that system is the pelvis, and here McTimoney chiropractors spend some time accurately realigning the pelvic bones before even beginning to adjust the spine with the toggle recoil adjustment. If the sacro-iliac joints are not balanced and the pelvis is not straight, then there is little chance that the joints of the lumbar spine will function correctly and this will have a compensatory effect throughout the spinal column. An untreated misaligned low back can result in compensatory problems in the neck or upper back long after the apparent resolution of low back pain.

Attention is given to the knees and feet since making changes to the pelvis will inevitably change the weight-bearing load distributed to the lower limbs. The arms, wrists and hands are also adjusted, as are the cranial sutures.

Figure 2 Shoulder adjustment

History Taking and Treatment

At a first consultation with a McTimoney chiropractor, lasting approximately one hour, a full case history is taken regarding symptoms present and previous, as well as details of present health status, background, lifestyle, occupation, sports, hobbies etc. Gaining a picture of how a body is being used from day to day will often yield information about why it is malfunctioning. Patients are helped to understand how structure and use affect function by examining personal ergonomics and stress management to solve their back pain. Orthopaedic tests may be carried out.

A good history and examination will isolate the relatively few "red flag" patients where there may be fracture, cancer or infection.

The chiropractor will palpate the bony structure with the patient sitting as well as prone, adjusting individual bones and joints of the skull, thorax, spine, pelvis and limbs as needed, realigning and rebalancing the entire body. The bones are never forced into place, but by adjusting with a very rapid thrust and immediate release, the bone being adjusted "toggles" or rebounds towards its correct position. There is rarely any cavitation or "gapping" of joints since the McTimoney technique relies on speed of adjustment and the natural elasticity of tendons and muscles to permit realignment.

Because of this the treatment is gentle and generally comfortable to receive. The neck is adjusted by treating each of the seven neck vertebrae individually.

How Many Treatments?

The number of follow-up treatments, lasting from 30–45 minutes, will vary considerably depending on a patient's age, lifestyle, general health and the length of time they have been suffering.

The acute problem is generally more quickly resolved than the chronic, but very broadly speaking an initial treatment plan of 6 sessions is suggested, although of course more sessions may be required. The first three treatments are given weekly and subsequent treatments spaced out to two weeks, then four weeks, gradually allowing longer periods between treatments. Once a problem has been resolved, a maintenance programme of check-ups and treatment at three or six months is always recommended.

Types of Patients Referred for McTimoney Chiropractic

The treatment is suitable for all ages, from the very young to the old and frail. A recent Survey of Clients3 commissioned by the MCA revealed that the most commonly presenting symptoms are pain in the lumbar region (62%) and cervical pains (45%). Most patients are self-referred, although some practitioners are well known to their local GPs who refer patients to them. On average, 60% have already visited their GPs with their problems. Quite often patients end up seeing a McTimoney chiropractor as the little-known last resort – they have tried everything else!

Reactions to Treatment

During a course of treatment physical changes can occur as the muscles, soft tissues and the skeleton are realigned. These changes may include a brief period of stiffness, soreness, tiredness and the occasional muzzy head; sometimes patients can feel worse before there is improvement, although more often there is a feeling of wellbeing. According to the Survey4 already mentioned, 85% of respondents felt McTimoney chiropractic had been "very beneficial" in the management of their condition. 89% of respondents rated their satisfaction with McTimoney chiropractic treatment as either "extremely satisfied" or "very satisfied".

Onward Referrals

If pathology is noted in the history taking or by observation, a patient is referred back to their GP for other medical investigation or for diagnostic x-ray. Other alternative medical disciplines may also be referred to, for example: acupuncture, remedial massage, homoeopathy, nutritional advice or counselling/psychotherapy, as considered appropriate.

X-ray Imaging

Chiropractors throughout the world often have x-ray equipment in their clinics and are trained in taking and interpreting radiographs, and some chiropractic systems encourage routine plain film x-ray examinations and analysis for most adult patients.

McTimoney chiropractors choose not to take them and prefer to refer patients back to the GP when diagnosis suggests a need for x-ray imaging. Skilful history-taking and differential diagnosis help the practitioner to analyse the patient's state of health. If a fracture, infection or tumour is suspected, then obviously and immediately the patient would be referred back to their own GP for imaging, laboratory tests or referrals to medical specialists. No treatment would be given. Moreover, the list of contra-indications to treatment eliminates the need for pre-treatment x-ray, for example gross arthrodeses and Downs' syndrome.

McTimoney was working at a time when radiographic images were used to measure subluxation, but it was his view that if a bony subluxation could not be palpated, then it could not be treated by the McTimoney method which is dependent on palpatory findings and not x-ray findings. Ahead of his time, Mac also thought that the least exposure to radiation as possible is advisable when what is being encouraged is the healing process in the body.

Moreover, in a general review of low back pain,4 Andrew Frank, Consultant Physician in Rheumatology and Rehabilitation at Northwick Park Hospital in Harrow, concluded "up to 85 per cent of patients with low back pain cannot be given a definitive diagnosis because of the poor associations between symptoms, signs, imaging results and pathological findings".

Training and Qualifications

Students at the McTimoney Chiropractic College in Abingdon follow a course over four years leading at present to a Higher Education Diploma in Chiropractic. The training involves both the acquisition of academic knowledge and the development of practical skills. An extensive clinical programme brings students into contact with patients and allows them to reinforce their learning and develop patient management. The McTimoney course is validated by the University of Wales and it is aiming to convert the current Diploma course into a BSc in the next two years.

In order to go forward to Registration, all chiropractic colleges have agreed to meet the European Chiropractic Council of Education (ECCE) 1992 minimum standards or such equivalent standards as the Council may determine at Registration.

Case Histories

Post-Operative Pain

At the age of 20 a self-employed plumber had lifted a heavy weight, his back had "locked". Medical investigations showed no abnormalities. He is now 31, having suffered periodic episodes of debilitation through back pain. Twelve months before attending a McTimoney chiropractor, he had undergone surgery to remove a lesion (not cancerous) in the lumbar region. Following surgery he was hardly able to walk, let alone work, because bending down caused such acute pain. Further investigative surgery was undertaken, plus administration of steroid injections to aid mobility. Patient still unable to walk or bend and attended chiropractor as a last resort – the pain was ruining his marriage and his life.

He had one treatment (lumbar spine not treated) after which he had massive reactions 24 hours later. These included his legs giving way beneath him and tingling down his spine and both legs. After one week of resting completely he was able to go on holiday, take a walk every evening, then return to work and finding he could bend down again, rang to say he felt "the best he had been in ages" and for the first time since well before the operation he had no pain. Three further treatments and this is still the case to date. Only returns for treatment if he feels "tweaky".

Headaches

A 16-year-old violinist suffered headaches when playing. She also had left knee pain, both foot arches were dropped causing difficulty after walking for ten minutes or more. Physiotherapy tried but no change in symptoms. Patient was treated as per McTimoney Chiropractic protocol as necessary and after six sessions all symptoms were gone. Three years later no problems have returned.

More Headaches

A little girl of 7 presented with stomach aches and frontal headaches on waking most weekdays, pins and needles in her hands, having had the symptoms for about a year. The mother had recently remarried and had a new baby and was on the point of seeking psychiatric help for her daughter. History revealed the child had fallen, hitting her head, aged 18 months.

Chiropractic examination showed subluxation of all cervical vertebrae, left TMJ and right lacrimal bone. She had 4 treatments and at the last consultation had experienced only 2 headaches in the previous 2 months and only 1 episode of stomach ache. Mother now feels guilt-free and acknowledges physical origin of problem.

Insulin-dependant Diabetes

A 59-year-old female Nursing Auxiliary attended clinic suffering with pain in neck, shoulders, lumbo-sacral pain, and bilateral thigh and ankle pain. She was diagnosed by her GP as having rheumatoid arthritis although there was no joint swelling and the ESR was not raised. After one treatment, she had two pain-free days and then symptoms returned. After the second treatment she had a strong reaction and was in severe pain for 48 hours followed by feeling much freer. After 12 treatments over the course of a year, all pain had gone completely. At the latest visit to her Endocrinologist, who she sees about her insulin-dependant diabetes, she was advised that her blood sugar is so well under control that now she can stop the injections and control her condition with diet and tablets rather than injections.

Scheuermann's

A 14-year-old boy presented with severe constant back ache in the lumbar region and coccygeal pain, as well as headaches. Orthopaedic Consultant diagnosed Scheuermann's kyphosis, and the parents were advised no action be taken medically, save patient not to play games again. The patient was devastated as he lived for sport and could not lift himself from the depression caused by the diagnosis.

The main issues were a pelvic tilt and rotation with lumbar involvement. Patient had 9 treatments over 5 months which reduced back pain to a feeling of weakness in the lumbar region and no coccygeal pain. Six months later he is fully active, lives for sport, and although knows his limits and doesn't feel the need for further treatment (though he will come back for regular preventative treatments).

A Crooked Rib

45-year-old fireman was in excruciating chronic pain in the anterior upper right hand side of his rib cage. X-ray and medical investigations had revealed no abnormalities so he was at a loss to understand the pain, and confessed to becoming quite depressed by his condition.

Palpation showed the second rib to be subluxated. This was adjusted using the toggle torque recoil (not the conventional McTimoney rib adjustment). The patient's pelvis and thoracic spine were also somewhat misaligned. At the follow-up treatment one week later, patient reported himself to be virtually free of pain. His skin tone had changed from a pale grey to a healthy pink.

Patient has very occasional reoccurrence of "a shadow" of this pain, depending on work he is doing, and attends for six-monthly maintenance treatment.

Summary

McTimoney chiropractic is a gentle, whole-body approach for adjusting the skeletal frame of the body. The importance and accuracy of case-history taking is stressed, allowing clear recognition of contra-indications to treatment. There is no attempt to remove symptoms, but to correct the causes with a minimum of intrusion. An understanding and communication of the healing process to the patient is at the core of the treatment philosophy.

McTimoney chiropractors seek to promote good health primarily through treatment – achieving balance of alignment in the spine, and secondarily through education – helping patients to understand correct body use as well as balance in lifestyle. Prophylactic maintenance treatment is also an important part of the McTimoney philosophy – we do not expect our cars to run perfectly forever without servicing, tracking and balancing, so why should we expect our bodies to do so?

References

1. Rosen, M. et al Back Pain. Report of a CSAG Committee on Back Pain, Chaired by Professor Michael Rosen, May 1994. HMSO.
2. Royal College of General Practitioners, Clinical Guidelines for the Management of Acute Low Back Pain, GP62 9.96, September 1996.
3. McTimoney Chiropractic Association, 1997 Client Survey Results.
4. Frank, A. British Medical Journal, 3 April 1993.

Further Information

For a list of McTimony Chiropractors, phone the McTimony Chiropractors Association, Tel: 01865 880 974.