Making progress in any area of life can often feel like taking one step forward and two steps back, and this can be true in chiropractic care too. This feeling of having to repeatedly achieve the same milestones in progress is referred to as “retracing”. Like many historical concepts, the mechanisms underpinning this phenomena haven’t always been obvious, but a recent article published in the Journal of Contemporary Chiropractic discusses retracing, exploring its historical roots, scientific underpinnings, and implications for patient treatment.
In 1910, B.J. Palmer stated, “A common question which Chiropractors and their patients have to face is the question of Retracing.” Described as “going over ground which has already been covered,” the patient under care may “exhibit symptoms which have not manifested themselves for months, or even years. [The patient’s] first impression is that he is becoming worse, but the facts remain that he is retracing the several stages through which his disease progressed in the making.” [1]
Many chiropractors have encountered new patients who expect a single adjustment to resolve a chronic condition, but this is not usually how treatment progresses. Generally, the longer a condition persists, the more time it takes to resolve. We know that a patient’s recovery from illness is often not smooth, with progress sometimes quick at first, but then plateauing or regressing during the course of care. This regression, while common, can lead to the patient becoming discouraged and possibly discontinuing care. However, this challenging process, known as “retracing,” is a normal part of recovery and has been acknowledged by chiropractors for generations.
“Every case retraces, for if there is a departure from health, there must be a return to it if there is restoration. When a case retraces, it passes back through the successive steps, in reverse order, that it passed through in getting worse.” Dr. R.W Stephenson
A new theory on the phenomena of retracing
Biological sciences were not as advanced as they are today, back in D. D. Palmer’s time. As the field of chiropractic research has emerged and the techniques and tools we have at our disposal have improved, we have been able to fill in many of these scientific gaps that underpin the chiropractic philosophy. [2] While retracing is frequently observed in practices, and has been for a long time, the mechanism driving the effect has remained elusive.
The recent article published in the Journal of Contemporary Chiropractic suggests ischemia-reperfusion injury may provide the insight needed to better understand why retracing happens. Ischemia-reperfusion injury occurs when an area that has previously had restricted blood flow (ischemia) experiences further damage when it regains blood flow (reperfusion). [3] It is often referred to as a paradox, as the process that recovers the tissue causes further damage.
As we know, chiropractic care often focuses on removing nerve interference, such as a subluxation causing nerve pressure or compression. Although adjustments can relieve pressure and restore normal blood flow, it may also lead to an increase in free radicals and damage associated with ischemia-reperfusion injury. However, relieving the pressure is essential for healing. [4] Even the mildest pressure can interrupt blood flow in nerve roots, meaning even small tweaks can make a difference. No matter what the mechanism that produces pressure on the nerve root, it appears that sufficient pressure on either the venules or the capillaries would produce ischemia in the nerve root. [5]
Part of the damage caused by ischemia-reperfusion injury is due to the increase in free radicals that accompanies the return of blood flow. Free radicals are unstable atoms that can cause cell damage, they have been linked to the processes of aging and illness. When blood flow is restricted there is an increase in free radicals which causes damage. This damage is further worsened when blood flow returns as free radicals are increased further. [6] This generation of free radicals during ischemia and again during reperfusion, and the subsequent damage sustained by the surrounding tissues, may contribute to the explanation of how and why retracing occurs during chiropractic care.
While this explanation may not apply to every case, it is certainly plausible for many. New articles in this area of chiropractic research, such as the one recently published, may lead to constructive conversations and increased confidence in the care practice members are receiving. This is especially true for those practice members who may be experiencing retracing as they move toward a better quality of life.
It is valuable to consider historical concepts together with the new explanations we have as to why they happen, as we continue to push for greater understanding and improved practices through chiropractic research. We are excited to see how future research continues to explain and confirm long accepted chiropractic concepts.
REFERENCES:
- Palmer BJ. 1920. Retracing, Our Course Back to Health. Pamphlet.
- Asimov, I. 1984. The History of Science: 19th Century. Harper & Row
- Zhang, M., Liu, Q., Meng, H., Duan, H., Liu, X., Wu, J., Gao, F., Wang, S., Tan, R., & Yuan, J. (2024). Ischemia-reperfusion injury: molecular mechanisms and therapeutic targets. Signal Transduction and Targeted Therapy, 9(1).
- Gao, Y., Wang, X., & Weng, C. 2013. Changes in nerve microcirculation following peripheral nerve compression. Neural Regen Res.8(11):1041-1047. doi:10.3969/j.issn.1673-5374.2013.11.010
- Olmarker K, Rydevik B, Holm S, Bagge U. 1989. Effects of experimental graded compression on blood flow in spinal nerve roots. A vital microscopic study on the porcine cauda equina. J Orthop Res. 7(6):817-823. doi:10.1002/jor.1100070607
- Sun MS, Jin H, Sun X, et al. 2018. Free radical damage in ischemia-reperfusion injury: an obstacle in acute ischemic stroke after revascularization therapy. Oxid Med Cell Longev. 3804979. doi:10.1155/2018/3804979
