From its beginnings a century ago, chiropractic techniques have been scorned by medical doctors who challenge many of chiropractors' basic claims. In recent years, chiropractors have split into two camps defined by how much good they believe they can wield through standard spinal manipulations.

Both sides agree that relieving pressure on nerves exiting the spine allows the body to return to a more balanced state. But while some chiropractors believe spinal manipulation should primarily be used to alleviate pain, others adhere to the more controversial belief that chiropractic techniques can correct problems with internal organs, and even be used to treat allergies and infectious diseases.

 

On one side of the fence are practitioners who generally stick to using chiropractic techniques for back and neck pain abatement, and to adjust misaligned spines. Known as "mixers" in the field, they constitute the vast majority of practicing chiropractors and typically blend the principles of chiropractic with other health modes, ranging from conventional medicine to herbalism to orthopaedic and other medical doctors. They tend to take a holistic look at the patient and often make suggestions for healthier lifestyles, including such things as nutrition and exercise. They also rely on standard scientific research for proof of claims.

 

 

On the other side are the much smaller percentage of chiropractors who see themselves carrying on the pure chiropractic tradition of its founder, D.D. Palmer. Palmer believed that the basic cause of disease was interference with the body's nerve supply and that healing could come from correcting so-called "subluxations" through hands-on manipulation of the spine. This group is often called the "straights" or fundamentalists because they are more apt to use spinal manipulation for more than just back and neck pain.

 

Some "straights" may not believe in medical diagnoses of conditions, such as high blood pressure, ulcers and allergies. Some don't think childhood vaccinations are necessary.

Sid Williams, the embattled founder and president of Life University in Marietta, adheres to the less common old-school beliefs, chiropractic experts say.

"Williams is as straight as they come," said William Jarvis, professor of public health and preventive medicine at Loma Linda University in California. "His view is the original view, that the life force is mediated through the spine and these subjective subluxations impede the body's natural healing ability. If you keep the spine adjusted, the life force flows freely and the body can heal itself."

Georgia has about 4,800 licensed chiropractors. About 1,500 to 1,800 of them are actually practicing, roughly 1,000 in metro Atlanta.

To become licensed, they must graduate from an accredited school and pass a national board exam. Annually, 20 hours of coursework is needed to maintain their license.

"Neuromuscular relief is about 85 percent of what chiropractors do," said Dr. Arch Culbreth, a Savannah chiropractor and president of the Georgia Chiropractic Association.

Culbreth said he wasn't surprised when the Council of Chiropractic Education revoked Life University's accreditation this month.

"We hate to say we told you so but we knew this was coming for a long time," Culbreth said. "We've had some real problems with that college. They have the most students who've defaulted on student loans and their standards for accepting students are generally lower."

The controversy over basic chiropractic theory is at the center of the Life University controversy, experts said.

The Council on Chiropractic Education "is trying to bring chiropractic into the mainstream," Jarvis said. "It's the progressives against the historical chiropractors."

The debate is not new. But it's definitely getting louder.

"These schisms within the chiropractic profession are deep and have gone on a long, long time," said Paul Shekelle, director of the evidence-based practice center at the Rand Corp. "The pragmatists view the straight guys as people who are impeding the progress of the profession toward wider acceptance. The straights think the pragmatists are selling out the practice, that they really want to be mini-physicians."

Not all alumni of Life University adhere to Williams' views. Dr. John Dull, who graduated from Life in 1981 and practices in Atlanta, said he left the "straight" philosophy behind when he started treating patients.

Dull, who considers himself a "mixer," primarily treats back pain, combining spinal manipulations with ice, ultrasound, electrical stimulation and other therapies. He frequently refers patients to medical doctors. He told a woman who recently came in with a bruised and swollen forearm after falling on the sidewalk to check with a medical doctor for possible vascular injury.

"Chiropractic has been around for 100 years," Dull said. "If the adjustments actually cured all forms of disease, we would have seen it by now."

The irony of the debate is that chiropractors are much more accepted today by the once-skeptical public. It's the most popular form of alternative medicine, health insurance and Medicaid cover visits (for neuromuscular relief only) and dozens of medical studies have proven spinal manipulation works for acute lower-back pain.

"There's proof that with certain types of back or neck pain, chiropractic care can be helpful. So it's purely spine-related," said Dr. David Hubbell of the Spine Center at Emory University and an assistant professor of orthopaedics.

More and more, referrals come both ways between chiropractors and medical doctors, Hubbell said. Chiropractors will send patients his way if they think they need prescription pain medication, cortisone shots or sophisticated X-ray exams, such as MRIs.