5.WFC Consultation on the Identity of the Chiropractic Profession. Available at www.wfc.org.
6.Rosner A. Chiropractic Identity: The Morning After. Dynamic Chiropractic, Sept. 1, 2005;23(18).
7.McDonald W, Durkin K, Iseman S, et al. How Chiropractors Think and Practice. Institute for Social Research, Ohio Northern University; Ada, OH, 2003. www.chiropracticsurvey.com
8.Kent C. Examining Exams - Are They Reliable? Dynamic Chiropractic, Aug. 12, 2008;26(17).
9.Council on Chiropractic Practice. Vertebral Subluxation in Chiropractic Practice. Revised 2008. www.ccp-guidelines.org/guideline-2008.pdf. Summary available at: National Guideline Clearinghouse (www.ngc.gov).
Chapter Four
Giving Birth to Health
Few are familiar with the term salutogenesis, yet it expresses the very essence of wellness. Antonovsky1 coined the term in 1979. It is derived from salus, which is Latin for health, and genesis, meaning to give birth.
As Cowley and Billings wrote: "Salutogenesis literally means 'that which gives birth to health.' In traditional public health and community medicine approaches, a 'pathogenic' perspective, in which the focus is on disease or illness and its prevention or treatment, most often dominates interventions. Adoption of a salutogenic perspective highlights the importance of starting from a consideration of how health is created and maintained."2
Salutogenesis is the opposite of pathogenesis. Pathos means suffering; pathogenesis is the birth of suffering. Ironically, most health professions have this term incorporated in their names. For example, conventional medicine is known as allopathy. Even alternative medical systems, such as homeopathy, naturopathy, naprapathy and osteopathy, incorporate pathos in their names, and a focus on disease prevention or treatment is implicit in their clinical strategies. In contrast, salutogenesis is the creation of health and well-being. While the prevention and treatment of disease has its place, it is a dangerously incomplete approach for inculcating and cultivating human potential.
The salutogenic model addresses the causes of global well-being rather than the origins of specific disease processes. It focuses on strategies and lifestyle choices that empower individuals to experience the full spectrum of the human experience.3
A Sense of Coherence
Antonovsky proposed that the key factor in salutogenesis is a person's sense of coherence (SOC). He defined SOC as "a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one's internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected."1 Kobasa4 described three common factors in people who enjoy health, even when confronted by challenging circumstances:
Smith5 published a comprehensive review of salutogenic mechanisms in the brain, noting that the components of a person's SOC are comprehensibility, manageability and meaningfulness. Other factors that contribute to salutogenesis include social support, spirituality, happiness, humor and love.
Salutogenesis is more than a realization that attitudes affect outcomes. Salutogenic theory goes to the very essence of neurobiology. It has been noted that neurological processes (as well as anatomical structures) are remodeled by sensory input. These processes, collectively termed neuroplasticity, are operative at all levels of the nervous system. Smith described the range of these mechanisms:
"From the afferent (incoming) activity of peripheral sensory receptors to the efferent (outgoing) activity directed toward neuroendocrine organs, blood vessels, and muscles. Although the selectivity of perception probably makes it impossible to be aware of everything that is happening throughout the body, it is evident that these regulatory processes are essential for one's health, and that they provide the basis for functional salutogenic mechanisms of the brain." Smith further noted: "An organism with a salutogenic brain would experience the world as manageable and coherent ... with a self-perpetuating cycle for enhancing self-confidence and well-being."
Salutogenesis and Chiropractic
From a chiropractic perspective, a salutogenic brain is one that receives information concerning internal and external environments without interference. If this world view and self-image are not distorted, the brain will issue mental impulses, unimpeded by vertebral subluxation, that give rise to qualitatively and quantitatively appropriate responses. As the process of life unfolds, the human experience sculpts the anatomical and functional mechanisms of the nervous system. Whether the result is a life which gives honor and dignity to our potential, or a grotesque caricature of the life which could have been, is up to us.
As human beings, we have the ability to control the modulating factors in salutogenesis. We can choose to experience social support, spirituality, happiness, humor and love through a nervous system free of distortion and interference. We can exercise control, commitment, and challenge through biomechanisms that are not compromised.
Recent research involving a central data repository of chiropractic offices has shown how a philosophical construct can become a clinical reality. McCoy6 reported on the results of an 18-week protocol using objective assessments of anthropometric and physiologic function. The study, which included 178 subjects, reported: "Anthropometric and physiologic measures showed improvement following the intervention; therefore, this standardized wellness protocol was shown to improve weight, heart rate, blood pressure, strength, body-mass index, and forced vital capacity. Paired sample t-tests and significance testing for the entire sample, and for both genders separately, determined that these changes were statistically significant."
It also was noted: "The intervention encompasses physical, biochemical, and psychologic dimensions and each is customized based on the client's wellness goals, the completion of a health survey, and results of a physiologic evaluation. This process attempts to uncover areas in each aspect of the client's life needing attention ... [It] incorporates a model of wellness care that integrates the physical, biochemical, and psychologic dimensions of health to address these behaviors...Some subjects also received chiropractic care during the program. All of the participating clinics practice a form of chiropractic that involves management of vertebral subluxation. This application of chiropractic is not solely directed at spinal manipulation for the treatment of neuromusculoskeletal pain syndromes. It is based on the contention that misalignments and/or abnormal motion of vertebral motion units may compromise neural integrity and may influence organ system function and general health and well-beings Chiropractic care of this type has been shown to improve self-reported quality of life and to correlate with improved health behaviors."6
As chiropractors, we have the ability to empower others to lead salutogenic lives and move our culture into one of worldwide wellness. By correcting vertebral subluxations and addressing lifestyle issues, our profession has the clinical tools needed to lead the transformation from a disease-centered system to one that indeed gives birth to health.