The specific listings, even when we get them right, might amount to the various tips of that holistic iceberg. From an interventionist point of view, we need not obsess on which is the right listing. Even though some approaches may result in a better outcome than others, the global analysis provides a menu of possible interventions, all mechanically consistent, and none likely to do harm. In the figure, the lumbopelvic distortion seen in the figure is the listing, regional in nature and worth of multilevel intervention. It is hard to attend a research or a technique meeting these days and not encounter skepticism about the importance of segmental specificity.
Regional problems require regional solutions.
It is intuitively obvious what that concept might have meant to the founders, both clinically and commercially for the purpose of product distinction, but it just hasn't played out very well. Although we would expect experienced clinicians to not get too hung up on the problem, we have seen the specificity albatross have a major negative impact on chiropractic technique teaching programs. It may also be impacting negatively on the clinical practice of chiropractic, in the form of suboptimal interventions having been inspired by preconceived notions. At every meeting of the American Back Society, you'll hear that a good surgical outcome depends on the right surgeon, doing the right surgery, on the right patient, at the right time, for the right reason. Students don't see at first that the surgery metaphor is much abused when applied to a manual, conservative care setting.