Thanks Ginger. The following is simply my opinion...

I can appreciate your position. My question to doctors and researchers has always been: 85% of people low back pain at some stage of their lives, some ridiculously high level of them have what is termed "non-specific low back pain" - what is the common thread?

Now i believe that your response would be your referred events from spinal joints, their associated structures and nerves.

Mine would be similar in that it would be spinal dysfunction and loss of motion control.

However, the complicated part of MSK treatments is once we have missed the boat. e.g. (in your terms) an L3 referred event leading to quads dysfunction leading to PFPS undiagnosed by either you or me ( ) which leads to Grade III chondral damage/wear.

Now what? Changing the spinal joints may mitigate the pain temporarily but not necessarily restore normal function to the muscle because it is now inhibited by physical factors and the pain returning.

We can choose denerative events from all joints as examples.

That is where i find the challenge - it is not actually getting them early that is a diagnostic and treatment planning problem, it is getting them LATE where there are now associated physical issues that i can't change that are the problem.

As for contributing to your profession and your lack of time...we all hear you. We are all busy. Being a business owner is more like buying your own job plus that of an accountant and practice manager!

You have mentioned that you teach - this should produce opportunities to hire talented students you could train to replace you. The ideal business model would have you doing minimal work with your employees doing the bulk of it. Read "Rich Dad, Poor Dad" for inspiration...

If you find your patients ONLY want to see YOU, then you need to raise your prices for YOU alone. This makes your employees more attractive to see for simple follow-up.

Lastly, if everything were so simple and easy to treat, you should have a massive patient load, been on TV by now and be internationally touring with courses booked out in advance. You should be rolling in it. You should have lots of physios wanting to work for you. You should have enough turnover to justify a practice manager. This should all lead to more time to share your "secrets" properly in a peer-reviewed process via research. If not you, then you should have sufficiently inspired others with your fantastic results to WANT to do research FOR YOU.

If not, why not?

Also, i have posted questions about spinal innervation elsewhere before

- how do you consider hitting one level will hit the problem level when spinal innervation has been shown to be up to 4 levels superiorly and 4 levels inferiorly (That is, L1/2 can affect up to T9/10 and down to L5/S1)?
- How do you explain that mobilisations at one level cause movements many segments above and below the level "mobilised"?

Personally I have been using spinal treatment for many problems for some time - i don't necessarily do CM - i mobilise (if i choose mobilisation) for as long a joint needs it (which is what i think you do too).

There are plenty of chiropractors and osteopaths who would agree with your reasons as to why events occur (and i agree too to a certain extent) but use manipulation to achieve their results.

But anyway, time is short - if you are truly open to challenge and discussion, please respond to the above points