Expanding the Horizon of Diagnostics

Dr. Rand Swenson, a second-generation chiropractor, received his chiropractic degree summa cum laude in 1976, from the National College of Chiropractic. He subsequently entered the graduate program in the Department of Anatomy at Loyola University Medical Center in Maywood, IL. His graduate research was in the field of neuronal plasticity and he received his PhD in 1981.

After a two-year post-doctoral fellowship investigating autonomic nervous system neurophysiology, he became a visiting professor of physiology at the Tokyo Metropolitan Institute of Gerontology, investigating autonomic nervous system responses to sensory stimuli, especially pain. During his time at the University of Illinois College of Medicine in Chicago, he was named a James Scholar and to the Alpha Omega Alpha (AOA) Honorary Medical Society. Dr. Swenson is currently the Associate Professor of Medicine (Neurology) and Anatomy and Acting Chairman of Anatomy Dartmouth Medical School.

This past year, Dr. Swenson became an active Advisory Board member of Diagnostic Testing Centers of America (DTCA).  DTCA serves as a national network of affiliated physician practices providing on-site precision diagnostic testing services.

In an interview with The American Chiropractor (TAC), Rand Swenson, D.C., Ph.D., M.D., discusses the growing trend toward bridging the differences between the chiropractic and medical communities. As an expert in neuroscience and neurology, Dr. Swenson explains how neurological evaluation can be of importance to the chiropractor.

TAC:  Being a chiropractor, what made you decide to attend medical school?

Swenson: There are several reasons why I entered medical school. In the 1980’s, it was apparent that there was growing interest, in the medical and chiropractic communities, in finding appropriate ways to integrate orthodox medicine with several “complementary and alternative” (CAM) practices. It was really during that decade—and during the early part of the 1990’s—that medicine was confronted with the widespread use of these practices, largely forcing their attention to this issue. Of course, there was not a great deal of expertise or understanding in the medical community as to what it is that CAM practitioners could contribute to patient care, much less how such care could be understood and integrated. I felt that there was (and continues to be) a need for practitioners, particularly in medical academic settings, who have an appreciation for both sides.

TAC:  How do medicine and chiropractic complement one another?

Swenson:  First of all, most of the patients who are most effectively cared for by chiropractors are patients for whom medicine has no clear or easy answers. This should be an ideal ground for synergy, and that is evolving, in many quarters. Of course, not all patients are good candidates, for one reason or another, for chiropractic care. Also, some need further investigation of potentially serious complicating problems before chiropractic treatment. It is in the latter area that medical physicians should be particularly skilled. Therefore, I do not view these two professions as inherently antagonistic (history notwithstanding), but rather complementary. All of this should be directed toward the maximum benefit of patients

TAC:  What advances have been made and/or are being made to integrate both chiropractic and medicine in today’s patient care?

Swenson:  I have seen major changes in the involvement of chiropractors in the medical system over the past 15 years, along with major changes in attitudes— both by patients and medical practitioners. I have been invited to give presentations at major medical schools, state medical society meetings, as well as national specialty society meetings on chiropractic. I don’t believe that this would have happened 15-20 years ago.

The predominant attitude that I notice from my medical colleagues, and particularly from the current medical students, is one of curiosity—curiosity about what it is chiropractors do and what they treat. Some of this curiosity has been motivated by an increasing willingness on the part of patients to report that they are seeing or have seen a chiropractor. I believe that there will be a day when chiropractic will be included as a part of most multispecialty clinics and, particularly, those clinics that focus on orthopedic issues and rehabilitation. I think that these types of clinics will be the entrée to broader interactions.

I believe that the studies conducted by Dr. David Eisenberg’s group at Beth Israel Deaconness Medical Center were the studies that truly motivated a lot of the increased interest on the part of medical practitioners in chiropractic and, indeed, complementary and alternative therapies in general. The most impressive thing to me is how few of my medical colleagues realize the number of their patients who are already utilizing chiropractors, mostly for conditions that are not very responsive to medical management.

I will never forget giving a presentation on chiropractic to the state medical society about seven years ago. One of the points that I made was that it was critical for medical practitioners to be sure that they understood about their patients’ use of all kinds of complementary and alternative therapies, including chiropractic treatment. I was asked how a medical practitioner could identify who were the most effective chiropractors in the area. I told them that their best resource was their patients, if they would listen to what they had to say about their experience with chiropractic care in a nonjudgmental way.

I—along with most of the other participants at the conference—was floored when one of the doctors jumped up immediately and said that no patient of his had ever been to a chiropractor. This, of course, was patently absurd, and it was apparent that he had simply intimidated his patients into silence. The interesting thing to me is  that everyone else in the room recognized this absurdity except, of course, the person who made the statement and, fortunately, this attitude is dying. The old joke in medicine is that attitudes change one funeral at a time, but I have observed changes that are substantially more rapid than that.

TAC:  What is the relationship between the orthopedic and neurological examination?

Swenson:  Orthopedic and neurologic examinations are complementary. The orthopedic examination is a structural examination and the neurologic examination is a functional exam. The orthopedic examination is designed to determine the tissue that is causing problems. By and large, it involves determining the particular positions and motions that reproduce the patient’s symptoms and signs. The neurologic examination is designed to test the integrity of the nervous system and neural responses.

TAC:  Why is neurological evaluation interesting for chiropractors and how can it help them in practices?

Swenson:  There are several reasons why the neurological examination and evaluation should be of interest to chiropractors. Firstly, patients expect, and have a right to expect, a thorough assessment of their conditions. Secondly, patients often have unrecognized problems that warrant further evaluation or that can complicate treatment. Thirdly, appreciation of the nervous system expands appreciation of the processes that attend dysfunction of any part of the body—these processes are not mysterious, although they may seem so at first.  Finally, in discussing and sharing patients with professionals of other disciplines, it is critical to have some common understandings as well as our own unique perspective. It is not important for chiropractors to be neurologists, for example, but it is important to recognize what is and isn’t normal, how that can impact treatment and what can or should be done to follow up on such abnormalities.

TAC:  What is your position on neurodiagnostic testing?

Swenson: There are limitations to the ability of the clinical neurologic examination to fully evaluate the nervous system. This is particularly true in the peripheral nervous system and in the sensory system. Since the nervous system works on the basis of electrical responses, electrical examination is appropriate. Electrodiagnostic testing is an extension of the neurologic examination, objectively answering the question of whether elements of the peripheral and sensory systems are intact, when the clinical exam cannot answer the questions with certainly. It also often uncovers additional levels of injury that are unrecognized clinically, due to the dominance of certain symptoms. Nonetheless, these additional problems may affect recovery and may necessitate different or additional therapy in order to hasten recovery. Finally, it is a fact of life that objective findings are always treated with greater deference than are subjective complaints. This may be in terms of explaining why patients have symptoms or even in answering questions such as, “Why is recovery taking longer than expected?” or “Are there additional problems complicating this patient’s response?”

TAC:  Any final words for our readers?

Swenson:  Try not to let the many pressures inherent in practice today distract you from your focus on patients.

Our sincere thanks to Dr. Swenson.  He may be reached at HB 7100, Dartmouth Medical School, Hanover, NH 03455.

Leave a Reply