Chiropractic History Volume 28, No. 2 - 2008 81 A Profession Seeking Clinical Competency: The Role of the Gonstead Chiropractic Technique MATTHEW J. AMMAN, D.C* The Palmer School of Chiropractic was in a clinical conundrum after the death of its icono- clastic leader B.J. Palmer. The school had left full-spine chiropractic in the 1930s when Palm- er perpetuated his upper-cervical specific Hole-In-One Technique. In 1961, the Gonstead Chi- ropractic Technique resurrected full-spine chiropractic at the fiagship school and became the cornerstone of the school's technique curriculum. This paper reviews the history of this name- brand chiropractic technique to add to our understanding of early chiropractic education. Introduction However, the advent and role of the chiropractic- scientist has recently changed the technique-war de- A major effort of the chiropractic profession in bate. The persuasion and rhetoric by this new type of its first one hundred years was gaining jjolitical le- chiropractor, based on science, has not only led to the gitimacy (1). It required enormous time and energy restructuring of academic departments by changing from chiropractic's political and educational leader- hiring and tenure procedures, but a new generation ship. To provide itself with the necessary framework of graduates with an evidence-based practice mind- to legalize, the reasons of why and how chiropractic set ([10], [11], [12]). As expected, they are markedly was different from medicine dominated chiropractic progressive by using hard and soft techniques, vari- consciousness ([2], [3], [4], [5]). Professional politics ous technologies and by hiring of massage therapists. has always united chiropractors; however, the prac- While the success of this new type of intellectual chi- tice of chiropractic is entirely a different matter. The ropractor is highly debatable, the structure and ori- technique wars of the 1950s that chiropractic critic entation of this model is significant in many ways. Samuel Homola, D.C, noted in his 1963 analysis of Many of these explorations are beyond the scope of chiropractic affairs revealed a healing art struggling tis paper, but this paper will highlight the important to define itself clinically (6). This lack of focus on ones: chiropractic art among chiropractic leadership within national associations and educational institutions per- First, the chiropractic-scientist is likely to de- mitted such schisms. Regardless, healthcare history velop and contribute to the corpus/knowledge has shown that inconsistent therapeutic effectiveness base important to developing chiropractic's can remain independent of professional development, professionalism and rise to power. In contrast, but it will remain a barrier to professional maturation numerous educational institutions have been ([7], [8], [9]). cognizant of marketplace needs and created The discussion about chiropractic technique is specific technicians (field-experts) whose complicated and argued from many different angles information coincides with chiropractors: and justifications. The larger and historical argument biomechanicál engineers, exercise physiolo- has been between uni-modal (straight) and multi- gists, occupational health nursesj doctors of modal (mixer) chiropractors. This may be a more physical therapy, physical aides, massage ideological in nature than anything more. The other therapists trained in specific soft-tissue pro- fundamental argument is the difference between uni- cedures, etc; modal procedures. In both situations, attempts to uni- fy practice procedures by either political or scientific Second, the chiropractor-scientist is perhaps means have failed. afforded a fast-track route to the institutions that currently hold power: hospitals, integra- © 2008 Association for the History of Chiropractic. tive health clinics, group-doctor practices, etc; * Address correspondence to Matthew J. Amman, D.C, 9217 West Center Street, Milwaukee, WI 53222, [email protected] The Role of The Gonstead Chiropractic Technique - Amman 82 Third, the chiropractic-scientist is prepared versified ([16], [17], [18]). Second, this author must to embrace new technologies and procedures define clinically competent. The assumption is that directly or indirectly complementary to chi- chiropractic has the purpose of correcting a sublux- ropractic's social fact of being neuro-muscu- ation with pain being the most obvious symptom. lar-skeletal specialists. The growth of sports The chiropractor, by definition, employs the high- chiropractic is a good example. velocity-low amplitude (HVLA) adjustment to cor- rect a subluxation. The field-practitioner confronts Although the chiropractic-scientist model may various types of pain; the most obvious type of pain have significant advantages, it ignores the pragmatic conducive to chiropractic adjustment is neuro-mus- question of does the patient get better because of this culo-skeletal (NMS) pain. An example for sake of new orientation. Putting the cart ahead of the horse is argument is the sacroiliac subluxation, a common common in the profession; and while the chiroprac- NMS malady. According to the training at PSC be- tic-scientist model on the surface seems to employ tween 1930 and the early 1960s, the Palmer graduate the most scientific forms of chiropractic, the evidence would be incapable of alleviating this type of pain, as hardly supports the position. The Journal of Manipu- evidence will demonstrate later. The works of Gillet, lative and Physiological Therapeutics, chiropractic's Gonstead, Logan and others were capable of correct- premier research journal, clearly points out that at ing this subluxation, but only by remaining outside this time only a few advocates of specific techniques the theoretical framework of B.J. Palmer and his HIO are interested in scholarly publishing (13). Rather, technique. That is, a full-spine chiropractic approach the emphasis by chiropractic's small scientific elite offered chiropractic a better strategy for power with is towards the broader questions of chiropractic in GCT being the provisional model (Diversified tech- the marketplace (chiropractic care effectiveness for nique would subsequently replace it). The following treating low-back pain, etc.) instead of optimizing key components made GCT attractive: practice procedures and comparative studies between techniques. 1) GCT has successful outcomes; As a result, chiropractic's periodicals have po- 2) GCT is full-spine; lemics on both sides of the issue advocating either the 2) GCT adjustments are HVLA; continued support for the old techniques, rich with 3) GCT hypotheses on spinal history and years of observational proof, or support biomechanics seemed plausible at the for the new techniques with arguments based on mar- time; and ketplace needs and/or the limited science. Keating, 4) GCT uses chiropractic machines. Cooperstein, and Gleberzon among others have pro- vided various contemporary observations to explain The final aspect of this author's archaeology this debate ([14], [15]). depends on the definition of chiropractic practice. An archaeology of chiropractic practice reveals Chiropractic's success is dynamic because of its non- an inter-connection between the dilemma of today's uniform styles of practice. To state that chiropractic's chiropractic-scientist and that of the old chiropractic- primary success is because of the HVLA adjustment is field-practitioner to reveal the paradox of chiroprac- both true and false. The professional fact is that some tic education. Ever since the formal development of chiropractors adjust, while others do not. Because ad- manipulation in the late nineteenth century by oste- justing is an art that requires skill to master, some are opathy and chiropractic, multitudes of strategies have adept enough to become more proficient than others. developed. The gaze of these diverse hand-healers re- This irregularity is inherent in all manual care (i.e., veals a progressive understanding, but the democratic chiropractic, dentistry, massage therapy, surgery). To nature of chiropractic led to clinical frustration among aid the practicing chiropractor, various strategies for the proletariat field-practitioner creating a plethora of creating patient dependency exist, often with the as- name-brand techniques. It was not until the revolt at sistance of chiropractic business consultants. These the Palmer School of Chiropractic (PSC), chiroprac- strategies include patient-doctor rhetoric (enneagram tic's flagship college, that things changed. This paper profiling, hyperbolic language, use of similes and revisits this period revealing the unique role Gonstead metaphors ([19], [20])) and ancillary therapies (e.g., Chiropractic Technique (GCT) played in chiroprac- nutrition, soft-tissue techniques, physiotherapy equip- tic's professional maturation. ment). As a whole, these can optimize the outcome But a cautionary remark should be recorded now. independent of a chiropractic HVLA adjustment. At First, skewed by its generic nature and commonness its farthest point, the incapable but psychologically in practice, previous chiropractic scholars and orga- astute chiropractor practices across the street from the nizations often categorize the GCT as separate and master adjustor. unique or under the label of Palmer Package or Di- In other words, we must establish the fact that Chiropractic History Volume 28, No. 2 - 2008 83 Clarence S. Gonstead, D.C, was a master adjustor. 1950, he set up his own clinic in Beaver