Systems Chiropractic™

A Body in Decline: Understanding Pain Beyond Injury

A few years before my retirement, a government department asked me to assess whether a chiropractor had been negligent in treating a patient. I received relevant case details and a thick stack of hospital records for review.

The patient sustained a work-related injury in her mid-forties, leaving her with persistent discomfort. For seven years, she managed her spinal issues with medication and limited rehabilitation. By the time she sought chiropractic care in her early fifties, her health had deteriorated beyond the original injury—her muscles had weakened, her endurance had faded, and even routine movements had become exhausting. This significant deconditioning had taken hold during what should have been her peak productive years.

She hoped to find relief where conventional medicine had fallen short, so she turned to chiropractic care. Over several weeks, she underwent multiple treatments, expecting improvement. Yet, instead of relief, she experienced only greater pain. Her knees continued to ache, her mobility remained restricted, and frustration set in.

Eventually, she discontinued chiropractic treatment, convinced it had failed her, or perhaps even worsened her condition. She returned to the hospital, consulting various specialists not only for her persistent pain but also for other general health concerns. However, despite her worsening symptoms, medical tests revealed no signs of new injury. An MRI showed only chronic wear-and-tear, with no indication that chiropractic adjustments had caused structural harm.

Two pages from a pain specialist stood out among sixteen medical doctors' notes. From his observations, I reconstructed the following scenario:

The specialist first examined the patient three years after her spinal injury, noting signs of a pain disorder with symptom exaggeration. Five years later, during their second consultation, he adopted a different approach—rather than conducting a physical examination, he focused on understanding her daily activities and observing her lower limbs. He noted that her condition had deteriorated further, her muscles exhibiting increased signs of deconditioning.

From these two interactions, spanning half a decade, the specialist concluded that her condition was unlikely to improve through rehabilitation. Instead of prescribing additional treatments or referring her to other specialists, he took a direct approach, encouraging her to exercise at home despite her pain.

Though he did not elaborate on his reasoning, his recommendation aligned with clinical science. Years of inactivity had left her body weakened, making recovery through passive treatments improbable.

To the patient, the timeline appeared straightforward—her condition had not improved following chiropractic care, and in her mind, that meant the treatment had failed or even worsened her symptoms. However, the reality was far more complex. Her experience was shaped by prolonged deconditioning, heightened pain sensitivity, and a nervous system wired to misinterpret normal sensations as suffering.

After thoroughly reviewing all records, I concluded that the chiropractor had acted within the standard of care expected from any competent practitioner in similar circumstances.

Yet, in retirement, I see this case as more than just a question of negligence—it is an opportunity for professional growth. While the chiropractor met the legal standard, should we not strive for better? Should we not refine our clinical judgment to recognize when a patient’s condition calls for a different approach? Deepening our understanding of pain disorders, deconditioning, and abnormal illness behavior could help us serve patients more effectively. Sometimes, the most professional decision is knowing when not to treat—or when to adjust our approach to align with current pain science.

Ultimately, patient welfare must remain our highest priority.