Dr. Matthew Kowalski has led the integration of chiropractic care in an academic setting at the Osher Clinical Center at Brigham and Women’s Hospital since 2007. Read his personal and professional insights about the evolution of chiropractic care in this interview by Osher Research Assistant, Esmee Goldfinger.
Q: What attracted you to chiropractic care?
My pathway into chiropractic was rather unconventional. Many, if not most, chiropractors either follow a family legacy into the chiropractic profession or were attracted to it through appreciating relief from treatment. My introduction to chiropractic was a bit different.
From a very young age, I knew that I wanted to be a doctor. Of course, my thoughts were focused on being a medical doctor. But, when I was about 14 years old, I watched a “60-Minutes” special that featured chiropractic and highlighted Joseph Janse, DC (University President) and the National College of Chiropractic. He discussed the central tenants of chiropractic; non-surgical / non-pharmacological care that worked with the body’s innate ability to heal. My interest was piqued, but I continued my focus on becoming a medical physician.
It was not until several years later, while I was in my undergraduate / premedical training that I actually met a chiropractor. Ironically, my introduction to a chiropractor came about while working as a nursing assistant in a local operating room. A gentleman who I was wheeling down for surgery inquired about my professional direction. When I told him that I was pursuing a career in medicine, he inquired whether I considered chiropractic! It turns out that his son was an accomplished chiropractor to whom he made an introduction.
I soon began treatment with his son for chronic neck pain and headaches that were the result of a childhood injury. After only a few spinal adjustments, my neck pain and headaches were being relieved. I was so moved by that experience that I wanted to do the same and refocused my interest in going to medical school to pursuing a career in chiropractic.
Q: Tell me about the shift from private practice to working in a hospital setting.
While attending my last semester at the National College of Chiropractic, I met a new faculty member, Dennis Skogsbergh, DC, who was being recruited to head up an innovative orthopedics residency in the college clinics. His knowledge base in orthopedics and diagnostic imaging was the most extensive I had encountered. I became his first resident.
During my residency, we developed collegial relationships with the spine center at Loyola University Medical School, as well as several local hospital orthopedic services. My training became interdisciplinary through hospital rotations which planted the seed for a future in integrative care.
Upon returning to Boston, I quickly learned that the medical climate was quite different from what we were able to create in Chicago. I wanted to create the same level of service for my patients, but the road to doing so encountered many obstacles.
In 1992, I opened my first chiropractic office and worked to build relationships with medical physicians. Every patient that I treated became an opportunity to collaborate. I shared my patient records with their medical practitioners, met with dozens of medical physicians and physical therapists and attended medical lectures; all to build a team of practitioners to care for the patients that I served. It all wasn’t smooth sailing though. I literally had many doors closed when I introduced that I was a chiropractor. In fact, at one local hospital, I was “uninvited” to medical grand rounds when the medical education director learned of my title. This fueled my pursuit of medical integration.
In 1994, when a landmark article by David Eisenberg, MD highlighted the use of integrative medical therapies in the United States, some doors opened. I was fortunate to meet an open-minded Medical Director at Braintree Rehabilitation Hospital, James Liljiestrand, MD who welcomed my request to bring chiropractic into the hospital; it was ground-breaking. For several years following, Dr. Liljestrand and I helped many other chiropractors and hospitals to add chiropractic to their roster of care. In 2000, Dr. Eisenburg called me and invited me to “participate in the ‘impossible’”, bringing chiropractic into an academic based medical center. Three years ago, I closed my portfolio of private practices and moved to the Osher Clinical Center full time. My goal now is to bring chiropractic to a higher level through further integration and research.
Q: Why is research important in the progress of chiropractic care?
For many years, chiropractic has survived through the results of its care; just as I had personally experienced. Patient reported outcomes from relief from a wide spectrum of health concerns fueled the popularity and public demand for chiropractic treatment, licensure and insurance reimbursement. However, patient reported outcomes are no longer enough to validate the need for any given treatment. The chiropractic profession is called to measure its clinical value based on the same metrics used throughout medicine; research trials.
But the need for research goes much further. We would like to understand the mechanisms through which chiropractic care works. Who are the optimal candidates for chiropractic care? Although the serious adverse events are reportedly rare, how safe is the care? Is it effective? How can chiropractic treatment be best integrated into healthcare and wellness promotion? Many questions are left unanswered. Research is the pathway to understanding.
Q: Where do you see the clinic going in the future?
I believe that chiropractic is here to stay, but the models through which it is delivered may change.
There is an increasing public interest in communication between their healthcare providers. One of the best mechanisms to do so is through more extensive and meaningful integration of medical and chiropractic care. I believe that the newer generations of medical practitioners will be open to improved interprofessional communication and collaboration. The systemic obstacles that prevented chiropractors from working with medical physicians are slowly being dismantled. Many contemporary medical practitioners are not even aware of past medical campaigns to “control and eliminate” the chiropractic profession. In fact, an increasing number of medical practitioners seek relief from chiropractic treatment.
I see a day when chiropractors meaningfully participate in the education of medical practitioners and more physicians embrace the chiropractic pain relief mantra of “chiropractic first, drugs second, surgery last”.
I see a day when health insurance companies endorse the cost savings benefits of chiropractic for spinal disorders and include it as a front-line treatment in integrative cost-sharing clinics.
I see growing opportunities for meaningful research that will aim at better understanding how chiropractic care works and how to deliver cost-efficient care in an environment of collegial, patient-centered care.
Q: What are some of the most noteworthy outcomes you have observed from chiropractic care?
Every day, I am taken aback by patient’s reported relief of pain and suffering that result from chiropractic treatment. Although the public thinks of chiropractic as “back doctors” who treat through “spinal adjustments”, many are not aware of the spectrum of chiropractic licensure, training and care. Many people don’t know that we are licensed to provide other hands-on treatments as well as advice on exercise / movement therapies, diet, ergonomics and mindfulness practices, among other care approaches.
Some of my most profound outcomes have centered around care of patients with disabling extremity disorders and headaches. One example that was reported this past month was from an accomplished pianist who needed to give up his musical passion 10 years ago due to disabling elbow pain. He felt that he had exhausted all treatment approaches but gave chiropractic a chance to help. After just 8 soft tissue treatments (Graston Technique), he was able to return to playing 40 minutes of piano every day, without pain! I love hearing my migraine headache patients tell me about how they have not needed rescue medications after beginning care. TMJ pain patients report how chronic pain, locking and dysfunction is relieved through chiropractic.
Q: What are the most important achievements of chiropractic that you have witnessed throughout your career?
- Wilk vs AMA – After a prolonged trial during which the Chester Wilk sued the AMA for conspiring to “Contain and Eliminate” the chiropractic profession, in 1987 Judge Getendanner rendered an opinion that the AMA had violated the Sherman Antitrust Act. This trial uncovered a systematic, multi-modal and extensive effort of the AMA to prevent chiropractors from having access to healthcare, educational and funding resources, with the goal of eliminating the profession. After this ruling was made, chiropractors soon gained access to referrals for medical diagnostics, medical referral networks and resources to help their patients. This decision has fostered chiropractic integration into the healthcare system and was recently published in “Contain and Eliminate”, authored by Howard Wolinsky.
- Veteran’s Medical Center –U.S. Veterans can now appreciate the benefits of chiropractic in over 200 VAMC facilities. In 1999, Chiropractic become a permanent and growing resource for the Country’s veteran population. Through this program, chiropractic internship and residency programs have been developed to help train the next generation of integrative practitioners; medical and chiropractic.
- Growing number of hospital-based chiropractors – Chiropractic is slowly becoming an integral part of many hospital institutions. Hospitals such as Lehigh Valley Health Network now employ a dozen chiropractors in attempt to manage the demand for the care. We are seeing similar growth around the country, as public demand and research fuels growth.
- Chiropractic research fellowships at Harvard and Yale – in 2021, for the first time, a chiropractor will begin a research fellowship through the Osher Center for Integrative Medicine and will train with the fellows in the longest standing T32 Integrative Medicine Research Fellowship. A similar program was also funded at Yale Medical School and has a healthcare policy focused agenda. Both fellows received full support through the NCMIC Foundation, Inc.
The chiropractic profession continues to evolve and integrate through education, research and clinical successes. As funding and policy inequities are resolved, integration and patient care quality can further improve.