A CBP® Instructor, Researcher, and Clinician’s Rebuttal to Allen Botnick, DC

Introduction

Near the end of 2003, an article appeared on the Quack Watch website critiquing the Chiropractic Biophysics Technique (CBP®) protocols, procedures and research publications. In my opinion, this web site masquerades as a scientific source for public protection. In my opinion, this site’s primary agenda is discrediting legitimate aspects of Complimentary and Alternative Medicine treatment approaches for patients suffering a variety of health conditions. To this end several non-allopathic (standard medical) treatment interventions have been criticized under the guise of science and public awareness. After reading the critique of the CBP® technique written by an Allen Botnick, DC, it was my opinion that his critique was full of fabrications, misrepresentations, and total one sided non-scientific arguments without proper scientific support.

Recently, one of my patients was referred to the CBP® Technique website, www.idealspine.com, for extra information on this highly supported chiropractic technique. Following this patient’s visit to our website, she desired further information and performed a google search on the CBP® Technique. She accessed and read the Quack Watch article written by Allen Botnick, DC. After reading this article, my patient was concerned and confused over what she had read regarding the technique my office utilized on her; which by the way dramatically helped her chronic pain conditions. This patient asked me if I could account for and properly rebut the criticisms offered by Allen Botnick, DC. I explained to her that I already had and promptly printed out a copy of the following article.

Because of my experience above, I decided to make this available to all CBP® Technique practitioners and patients. Please read the following and make an informed decision regarding the agenda and accuracy of this Quack Watch Critique of CBP® Technique.

The Source of the Quack Watch CBP® Critique:

The individual who wrote the Quack Watch article is Allen Botnick, DC. As always one should look at the credibility of the individual writing a critique and their qualifications as an expert in the respective field that the critique involves. To this effect, I found ZERO Index Medicus citations for Allen Botnick, DC on Pub Med. Allen Botnick, DC has never authored an appropriate literature review/critique in the scientific literature. Furthermore, Allen Botnick, DC has never sat on an expert panel, does not sit nor review for any scientific journals, and has never (to my knowledge) presented at a scientific conference on Chiropractic Sciences. Therefore, in my opinion, I conclude that Allen Botnick, DC is not an authority/expert in the Chiropractic sciences and techniques.

In contrast, I’m a formal researcher in the chiropractic sciences and educator for continuing education seminars for Chiropractors. As such, when I read Allen Botnick’s article on CBP® Technique, I was able to immediately spot misrepresentations, non-scientific supported arguments, and outright fabrications concerning his claims and references of such. I will provide rebuttal by analyzing his references and claims based on these, I will provide the known scientific research rebuttals as published by CBP® Technique, and then I will end with gross inaccuracies made throughout Allen Botnick’s article.

A) One might believe that Allen Botnick, DC used proper scientific references to support his critiques of CBP® Technique, however, the original report that was posted on Nov 24, 2003 contained 36 references (this has been altered now for unknown reasons?). Of these 36 references, 24/36 (including the two from the Drs. Peet) are actual CBP® published references that were written by CBP® authors and thus do not support any of Dr. Botnick’s claims of the reliability and validity concerns with CBP® technique.

B) Therefore, this leaves Allen Botnick, DC 12/36 references that might possibly support his criticisms. Of these 12 references, 3 of them have to do with orthotics, which have nothing to do with the reliability and validity of CBP® technique. In fact, in their seminars, Drs. Harrison (founders of CBP® Technique) discuss the use of orthotics and a short leg analysis with heel/shoe lifts (see Drop Table Adjusting Seminar outline on www.idealspine.com). Drs. Harrison have always taught that pelvic lateral translations and pelvic y-axis rotations cause foot pronation/supination problems and eversion/inversion problems.

In my clinic (Ruby Mt. Chiropractic), we routinely recommend orthotics for patients in need. Further, I utilize the Zebris Force Plate to analyze 3-Dimensional stress concentrations on the surface of the foot during static stance and dynamic gait to help decide upon the necessity of orthotics. This equipment is very sophisticated and is likely much more advanced than what Allen Botnick, DC, might use to analyze foot abnormalities. This was blatantly portrayed in the opposite manner in a whole paragraph, which appears fabricated by Allen Botnick, DC concerning some “deformed heel” story. Since there is no reference for such a statement/story, I conclude that this is a fabrication by Allen Botnick, DC in an attempt to make me and CBP® Technique look bad.

C) This leaves Allen Botnick, DC with 9 references of which 3 are from Non Scientific Journals (#34 is a telephone conversation, #30 is an Internet Chat room debate, #26 is the CRJ from Life and is not a index medicus scientific journal). These are not appropriate peer reviewed sources and are primarily personal opinions. It is interesting that one of these references is an “internet chat room” debate for which Allen Botnick references (#30 in his original Quack Watch article) Gary Knutson, DC as a Chiropractic Researcher and refers to him as an assumed authority figure.

I did a Medline on Gary Knutson, DC and found approximately 9-11 publications of which none were in Journals outside Chiropractic and none were critiques of CBP® Technique. While Gary Knutson DC should be complimented on his few research accomplishments, in my opinion, 9-11 publications hardly qualifies Gary Knutson, DC as an authority figure in Chiropractic. More importantly, Botnick’s reference to Gary Knutson, DC based on his “opinion” is a known fallacious argument in scientific evidence called the fallacy of Appeal to Authority.1 Why does Botnick reference “internet chat rooms” instead of proper scientific evidence? Why doesn’t Gary Knutson, DC write a formal letter to the editor in a scientific journal critiquing the CBP® work instead of side-stepping proper scientific forum? This leaves Allen Botnick, DC with only 6 credible references.

D) Of these 6 remaining references, 1 is from Petersen et al (JMPT 1999) on Facet Hyperplasia. Most DCs are obviously not aware that at the WFC May 2003 conference, I (Dr. Deed Harrison) presented a platform manuscript with 252 subjects (5 times more subjects than Petersen et al.) and found no correlation between facet angles, heights, shape of the dens and cervical lordosis.2 This manuscript was later published in the journal Clinical Anatomy3 (a high quality Anatomy journal put out by the Mayo Clinic). Since Allen Botnick, DC is not a formal chiropractic researcher, he likely did not attend the WFC conference research presentations where this manuscript was presented. Furthermore, he likely does not read Clinical Anatomy and seems to have ignored this rebuttal work by CBP®. Nevertheless, ignorance is not an excuse and in my opinion he has bias against the Harrison’s and CBP® Technique.

1. Stein F. Anatomy of Research in Allied Health. New York: John Wiley & Sons. 1976, pg 45.

2. Harrison DE, Harrison DD, Haas JW, Janik T, Holland B. Do sagittal plane anatomical variations (hyperplasia) of the cervical facets and C2 odontoid affect the geometrical configuration of the cervical lordosis? Results of digitizing lateral cervical radiographs in 252 neck pain patients. Presented at WFC 7th Biennial Congress, Orlando, FL. May 2003.

3. Harrison DE, Haas JW, Harrison DD, Janik TJ, Holland B. Do Sagittal Plane Anatomical Variations (Angulations) of the Cervical Facets and C2 Odontoid Affect the Geometrical Configuration of the Cervical Lordosis? Results from Digitizing Lateral Cervical Radiographs in 252 neck pain subjects. Clin Anat 2005; 18:104-111.

E) This leaves 5 references possibly supporting Allen Botnick, DC. One of these is Haas et al JMPT 1999. Of interest, this article is the middle reference of a 3-part debate between CBP® researchers and Haas et al.

I wonder why does Allen Botnick, DC discuss one of these (Haas et al) without the other two papers published by me and CBP®?4,5 In their May 1999, Haas et al wrote a rebuttal to a CBP® manuscript that appeared in May 1998 JMPT.4 Later in Dec 2000,5 the CBP® research team rebutted this Haas et al article with more than 6 times the scientific supporting references provided by Haas et al. The truth of the matter is that “in a blistering rebuttal”, We AT CBP® destroyed the Haas et al. arguments. Again, in my opinion, Allen Botnick, DC shows his ignorance of the literature and bias against CBP® Technique by his lack of providing both sides of this debate.

4.Harrison DE, Harrison DD, Troyanovich SJ. Reliability of Spinal Displacement Analysis on Plane X-rays: A Review of Commonly Accepted Facts and Fallacies with Implications for Chiropractic Education and Technique. J Manipulative Physiol Ther 1998; 21(4):252-66.

5.Harrison DE, Harrison DD, Troyanovich SJ. A Normal Spinal Position, Its Time to Accept the Evidence. J Manipulative Physiol Ther 2000; 23: 623-644.

F) This leaves 4 references for Allen Botnick, DC. One of these is a patient hand book or guide book for which Botnick claims there is proof that CBP® traction causes patients to have neck pain. I read this hand book and found absolutely no evidence provided for the incidence or prevalence of such claimed iatrogenic injury to patients. The only evidence I found was the personal opinion of the author (Homola). Again, this is not evidence this is pseudo-scientific evidence at best.

By way of comparison, the known morbidity and mortality rates for cervical spine surgery for cervical myelopathy can reach 2% for death rates (mortality) and 8% for complication rates (morbidity).6 The reader will note that I cited proper scientific sources for this not an opinionated hand book as Allen Botnick did. Perhaps Quack Watch would be better suited informing the public of known injury rates such as these instead of fabricated claims out of a non-scientific, non-peer-reviewed patient hand book.

Additionally, out of this same “Patient Hand Book” by Homola, Botnick claims that CBP® extension traction is a likely cause of stroke. Personally, I find this to be a serious breach of ethics and scientific documentation as evidence suggests that there is no known position of the cervical spine that has been specifically linked to stroke. In a 1999 review of the literature on varying positions of the head associated with vertebral and basilar artery blood flow and dissection, Haldeman7 concluded, “examination of the data fails to show a consistent position or movement of the neck that could be considered particularly dangerous”. In addition, Thiel8 found no occlusion of vertebral artery blood flow during various head and neck positioning tests on the patient, including head extension.

Lastly, just to be sure, I searched the scientific literature for studies possibly linking CBP® treatment to patient injury. I could not locate a single case report in the literature linking CBP® extension traction to stroke or to other injury. Stroke is a serious concern. However, for Dr. Botnick to make a statement that extension traction causes stroke without any data other than Homola’s (a non expert in stroke injuries) personal opinion (out of a patient handbook), is a serious breach of scientific ethics and evidence citing. Since Allen Botnick, DC has never authored a legitimate scientific study, he likely is not aware that this type of evidence would never be allowed in a scientific journal or debate (again ignorance is no excuse). But for Dr. Barrett, Quack Watch director, to allow this type of breach in scientific evidence, points to a probably bias against the Harrison’s and CBP® Technique.

Based on the above facts, it is my opinion that there is an agenda here to make CBP® Technique look bad. Instead of challenging them in the appropriate scientific forum (peer reviewed index-medicus journals) Dr. Barrett and Allen Botnick, DC have elected a forum for which there is no recourse other than Dr. Barrett’s. My perspective is that Dr. Barrett and Botnick and the like would lose a formal debate with CBP® Researchers if forced to follow the scientific etiquette of peer-reviewed journals.

6. Fouyas IP, Statham PFX, Sandercock PAG. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine 2002;27:736-747.

7. Haldeman S, Kohlbeck FJ, McGragor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after trauma and spinal manipulation. Spine 1999;24:785-794.

8. Thiel H, Wallace K, Donat J, Yong-Hing K. Effect of various head and neck positions on vertebral artery blood flow. Clin Biomech 1994;9:105-110.

G) This leaves Allen Botnick, DC with 3 references for which all are authored by Dr. Gore in Spine. Importantly and again, Allen Botnick completely ignored the work that I and CBP® researchers have published in rebuttal to Dr. Gore’s work. For example, I previously wrote a letter to the editor on Gore’s 2001 Spine manuscript.9 These articles have also been critiqued by me and others in CBP®’s Cervical Rehab text (2001 Chapter 3) and in two CBP® published scientific manuscripts.10,11

Concerning this debate, Gore et al. (Spine 1986) found an incidence of 9% of segmental kyphosis in 200 asymptomatic subjects and found no subjects to have a complete kyphosis from C2-C7. Compared to the data from Gore et al. in asymptomatic subjects, McAviney and Myself10 studied 277 patients (many with straight and kyphotic cervical curves) and found that these abnormal neck curves are 18 times more likely to present with neck pain and headache symptoms. This10 data strongly suggests that abnormal neck curves (kyphosis) are risk factors for neck pain. Additionally, Hardacker et al.12 and Harrison et al.13 demonstrated that segmental kyphosis is a significant risk factor for neck pain as it occurs 35%-39% of the time in symptomatic subject populations compared to 9% in asymptomatic populations (Gore). Several other high quality studies, with various pain groups matched to controls, have identified differences in the cervical lordosis.14-20 Again, these studies were intentionally ignored by Botnick.

It is my opinion that Dr. Botnick (and Dr. Knutson in his ‘chat room’ debate) purposely did a selective literature review on this topic. According to the information provided here, Botnick and Knutson have twisted the evidence in their favor and bias against the Harrison’s CBP® Technique is evident.

9. Harrison DE, Bula J. Response to Gore D. [Roentgenographic findings in the cervical spine in asymptomatic persons: A 10-year follow-up. Spine 2001;26:2463-6] Spine 2002;27:1249.
10. McAviney J, Schulz D, Richard Bock R, Harrison DE, Holland B. Determining a clinical normal value for cervical lordosis. J Manipulative Physiol Ther 2005;28:187-193.
11. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492.
12. Harrison DD, Harrison DLJ. Pathological stress formations on the anterior vertebral body in the cervicals. In: Suh CH, ed. The proceedings of the 14th annual biomechanics conference on the spine. Mechanical Engineering Dept., Univ. of Colorado, 1983:31-50.
13. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine 1997; 22:1472-80. Hohl M. Soft-tissue injuries of the neck in automobile accidents. J Bone and Joint Surgery 1974;56-A:1675-1682.
14. Zatzkin HR, Kveton FW. Evalutaiton of the cervical spine in whiplash injuries. Radiology 1960;75:577-583.
15. Kristjansson E, et al. Is the Sagittal configuration of the cervical spine changed in women with chronic whiplash syndrome? A comparative computer-assisted radiographic assessment. JMPT 2002;25:550-555.
16. Norris SH, Watt I. The prognosis of neck injuries resulting from rear-end vehicle collisions. J Bone and Joint Surgery 1983;65-B:608-611.
17. Kai Y, et al. Neurogenic thoracic outlet syndrome in whiplash injury. J Spinal Disorders 2001;14:487-493.
18. Nagasawa A, et al. Roentgenographic findings of the cervical spine in tension-type headache. Headache 1993;33:90-95.
19. Katsuura A, et al. Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disorders 1996;9:470-476.
20 . Kawakami M, Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disorders 1999;12:50-56.

Items Ignored by Allen Botnick, DC & Gross Inaccuracies/Fabrications:

Now that I have thoroughly analyzed and rebutted Allen Botnick DC’s references used to support his proposed criticisms of CBP® Technique, I will shift my rebuttal to show that Allen Botnick, DC has selective ignored a large quantity of CBP® published studies and presents Gross inaccuracies/fabrications in a purposeful attempt to discredit CBP® Technique.

H) CBP® Technique has published 6 Clinical Control Trials validating the treatment frequency, duration, and patient outcomes of care.21-26 These 6 published clinical control trials demonstrate that CBP® treatment methods (mirror image adjustments, exercise, and traction) combined with short term spinal manipulation can improve spinal alignment in the AP view and improve the cervical and lumbar lordotic curves. Additionally, these trials show that a CBP® 10-12 week, 36 visit program of care will reduce the intensity of chronic pain in the cervical and lumbar regions in patient populations. Lastly, 3 of these studies (22-24) have long-term patient follow-ups demonstrating that spinal corrections are maintained and that patient pains remain improved after CBP® care. See:

21. Harrison DD, Jackson BL, Troyanovich SJ, Robertson GA, DeGeorge D, Barker WF. The Efficacy of Cervical Extension-Compression Traction Combined with Diversified Manipulation and Drop Table Adjustments in the Rehabilitation of Cervical Lordosis. A Pilot Study. J Manipulative Physiol Ther 1994;17(7):454-464.
22. Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B. New 3-Point Bending Traction Method of Restoring Cervical Lordosis Combined with Cervical Manipulation: Non-randomized Clinical Control Trial. Arch Phys Med Rehab 2002; 83(4):447-453.
23. Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction and its Clinical Significance. Arch Phys Med Rehab 2002; 83(11): 1585-1591.
24. Harrison DE, Harrison DD, Betz J, Janik TJ, Holland B, Colloca C. Increasing the Cervical Lordosis with CBP® Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Non-randomized Clinical Control Trial. J Manipulative Physiol Ther 2003; 26(3): 139-151.
25. Harrison DE, Harrison DD, Haas JW, Betz JW, Janik TJ, Holland B. Conservative Methods to Correct Lateral Translations of the Head: A Non-randomized Clinical Control Trial. J Rehab Res Devel 2004;41(4):631-640.
26. Harrison DE, Cailliet R, Betz JW, Harrison DD, Haas JW, Janik TJ, Holland B. Harrison Mirror Image Methods for Correcting Trunk List: A Non-randomized Clinical Control Trial. Eur Spine J 2005; 14:155-162.

Few other Chiropractic Techniques have published Clinical Control Trials. While Clinical Control Trials are very time consuming and difficult to do, CBP® is doing these studies. Allen Botnick, DC made many untrue statements while not discussing the clinical outcome studies published by CBP®. The only missing studies are randomized clinical trials (RCT’s) documenting which aspects of CBP® treatment is responsible for the majority of pain, function, and health improvements. Research is a step by step process.

However, until such time that RCT’s are performed on CBP® technique, there is strong evidence in the form of well designed Case Reports that CBP® Technique treatment methods are superior to standard care (spinal manipulation and other typical treatments) for several chronic conditions. In these studies, CBP® Technique postural and spinal rehabilitation showed dramatic improvements in pain, ROM, disability scales, and health status (depending upon the study).27-33 Importantly, it is known today that well-done case studies (such as CBP®’s) most often demonstrate findings consistent with that of the RCT.34,35

27. Harrison DE, Bula JB. Non-operative correction of flat back using lumbar extension traction: A case study of three. J Chiropractic Education 2002;16(1). In review at the JMPT 2005.
28. Paulk GP, Bennett DL, Harrison DE. Management of a chronic lumbar disk herniation with CBP® methods following failed chiropractic manipulative intervention. J Manipulative Physiol Ther 2004; 27(9): 579e1-579e7.
29. Bastecki A, Harrison DE, Haas JW. ADHD: A CBP® case study. J Manipulative Physiol Ther 2004; 27(8): 525e1-525e5.
30. Ferrantelli JR, Harrison DE, Harrison DD, Steward D. Conservative management of previously unresponsive whiplash associated disorders with CBP® methods: a case report. J Manipulative Physiol Ther 2005; In Press for March.
31. Haas JW, Harrison DE, Harrison DD, Bymers B. Reduction of symptoms in a patient with syringomyelia, cluster headaches, and cervical kyphosis. J Manipulative Physiol Ther 2005; In Press.
32. Berry RH, Oakley PA, Harrison DE. A structural approach to the postsurgical laminectomy case. J Chiropractic Education 2005;19(1):44.
33. Oakley PA, Harrison DE. Use of Clinical Biomechanics of Posture (CBP®) protocol in a postsurgical C4-C7 total fusion patient. A case study. J Chiropractic Education 2005;19(1):66.
34. Venning GR. Validity of anecdotal reports of suspected adverse drug reactions: The problem of false alarms. BMJ 1982;284:249-252.
35. Benson K, Hartz AJ. A comparison of observational studies and randomized controlled trials. N Engl J Med 2000;342:1878-1886.

I) Allen Botnick, DC took several liberties with short summaries of different topics from the CBP® web site (idealspine.com). The majority of these were written by former Life University students who were learning CBP® Technique and wanted to help Dr. Joe Ferrantelli contribute to the website. Allen Botnick, DC claims that Drs. Deed Harrison and Don Harrison made these statements when in fact the Harrison’s’ did not author these (Botnick’s references #1,3,13-15,). If one read for the content of these summaries, one would notice that Allen Botnick’s summaries from those summaries are quite misleading. Lastly, once we found out that this information was on there and written by chiropractic students, we promptly asked Dr. Joe Ferrantelli to remove this area and he agreed as he did not actually check it for detailed content.

J) In another instance, Allen Botnick, DC fabricated quotes from Dr. Don Harrison. For example, Allen Botnick, DC claims that Dr. Don Harrison stated that 50% of patients discontinue CBP® treatment because of pain. After communication with Dr. Don Harrison (my father) and my own experience with CBP® Technique and seminars, I know that this is a fabrication by Allen Botnick, DC. In my opinion, this statement is a type of slander and is libelous. As per Allen Botnick’s own clinical mishap story, my opinion is this shows his incompetence as a clinician and is likely why he is rumored to have failed in private practice. The statement made by Botnick has no place in a true scientific debate/critique as it is hearsay and only supported by a non-credible source (Botnick himself) with an agenda of purposefully making CBP® Technique look bad. In my opinion, Dr. Barrett has the same agenda as he published this type of ridiculous evidence on Quack Watch.

K) To continue, Allen Botnick, DC stated “However, instead of criticizing chiropractic openly, Harrison created and marketed a technique that he alleged would correct these errors and improve outcomes,…” This is a grossly inaccurate statement and exactly opposite the truth. CBP® Technique (Harrison’s) have published numerous critical literature reviews, performed original studies, and have openly challenged traditional chiropractic systems.36-48 For Botnick to assert otherwise, only attests to his ignorance of CBP® publications in the peer-reviewed literature. Furthermore, I and Dr. Don Harrison attend multiple scientific conferences (WFC, RAC, ISSLS) and have sat on scientific panels where we “openly criticize chiropractic”.

36. Harrison DD, Colloca CJ, Troyanovich SJ, Harrison DE. Torque: An Appraisal of Misuse of Terminology in Chiropractic Literature and Technique. J Manipulative Physiol Ther 1996; 19(7):454-462.
37. Harrison DD, Harrison DE, Troyanovich SJ, Hansen D. The Anterior-posterior Full-spine View: The Worst Radiographic View for Determination of Mechanics of the Spine. Chiropr Tech 1996;8(4):163-170.
38. Harrison DE, Harrison DD, Troyanovich SJ. The Sacroiliac Joint: A Review of Anatomy and Mechanics. J Manipulative Physiol Ther 1997; 20(9): 607-617.
39. Harrison DE, Harrison DD, Troyanovich SJ. Three-Dimensional Spinal Coupling Mechanics. Part I: A Review of the Literature. J Manipulative Physiol Ther 1998;21(2): 101-113.
40. Harrison DE, Harrison DD, Troyanovich SJ. Three-Dimensional Spinal Coupling Mechanics. Part II: Implications for Chiropractic Theories and Practice. J Manipulative Physiol Ther 1998; 21(3): 177-86.
41. Troyanovich SJ, Harrison DD, Harrison DE. A Review of the Validity, Reliability, and Clinical Effectiveness of Chiropractic Methods Employed to Restore or Rehabilitate Cervical Lordosis. Chiropr Tech 1998; 10(1): 1-7.
42. Coleman RR, Bernard BB, Harrison DE. The Effects of Real Life X-axis Vertebral Translation on Projected Y-axis Vertebral Rotation Images. J Manipulative Physiol Ther 1998; 21:333-340.
43. Troyanovich SJ, Harrison DD, Harrison DE. Motion Palpation: It’s Time to Accept the Evidence. J Manip Physiol Ther 1998; 21:568-571.
44. Harrison DD, Colloca CJ, Troyanovich SJ, Harrison DE. Torque Misuse Revisited. J Manipulative Physiol Ther 1998; 21: 649-655.
45. Coleman RR, Bernard BB, Harrison DE. Measurements of 2-D Projected Images of 3-D Vertebral Rotation on the Y-axis. J Manipulative Physiol Ther 1999;22(1):21-25.
46. Coleman RR, Harrison DE, Fischer T, Harrison SO. Correlation and Quantification of Relative 2-D Projected Vertebral Endplate Z-axis Rotations with 3-D Y-axis Vertebral Rotations. J Manipulative Physiol Ther 2000; 23: 414-419.
47. Harrison DE, Harrison DD, Janik TJ, Holland B, Siskin L. Slight Head Nodding: Does it reverse the cervical curve? Eur Spine J 2001; 10: 149-153.
48. Coleman RR, Harrison DE, Fischer T. The effects of combined x-axis translations and y-axis rotations on projected lamina junction offset. J Manipulative Physiol Ther 2001;24(8): 509-513.

L) Allen Botnick, DC takes shots at the CBP® Normal Spinal Model and at the claims that alterations in the curves of the spine are linked to early degenerative joint disease (DJD). Botnick alludes to the posters on spinal decay. However, Allen Botnick, DC does not offer any references to the contrary in this section. Only his non expert opinion is provided. A close look at these posters will elucidate that DJD is only shown in the military, segmental kyphosis, and complete kyphotic spines.

According to the science of biomechanics detailing spinal loads, stresses, and strains, abnormal neck and low back curvatures (kyphosis) are indeed documented causes of spinal arthritis and disc disease. Multiple studies have identified that x-ray line drawing is able to determine that straightened, segmental kyphosis, and complete reversals of the sagittal curves are linked to premature degenerative joint disease.49-58 Of course to understand the mechanism one would need to have extensive knowledge of loads and stress generated potentials (Wolff’s Law) and it is my opinion that Allen Botnick, DC does not have formal training in the field of Biomechanics.

49. Harrison DE, Harrison DD, Janik TJ, Jones EW, Cailliet R, Normand M. Comparison of axial and flexural stresses in lordosis and three buckled configurations of the cervical spine. Clinical Biomechanics 2001;16:276-284.
50. Matsunaga S, et al. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine 2001;26:161-165.
51. Katsuura A, et al. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 2001;10:320-324.
52. Matsunaga S, et al. Biomechanical analysis of buckling alignment of the cervical spine. Predictive value for subaxial subluxation after occipitocervical fusion. Spine 1997;22: 765-771.
53. Borden AGB, Rechtman AM, Gershon-Cohen J. The normal cervical lordosis. Radiology 1960;74:806-810.
54. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 2001;10:314-319.
55. Oda I, et al. Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segments? An in vivo animal model. Spine 1999;24:2139-2146.
56. Umehara S, et al. The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine 2000;25:1617-1624.
57. Akamaru T, et al. Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments. A biomechanical analysis. Spine 2003;28:14:1560-1566.
58. Hohl M. Soft-tissue injuries of the neck in automobile accidents. J Bone and Joint Surgery 1974;56-A:1675-1682.

M) Continuing to make false statements about the CBP® Normal Spinal Model, Botnick asserts, “CBP® analysis does not appear to consider underlying causes of postural problems such as pregnancy, obesity, torn ligaments, foot pronation, muscle shortening, and malformation of vertebra.”

In complete contrast to Botnick’s statement, these issues have been addressed by CBP®. For examples,

1) concerning pregnancy, CBP® has published in the peer-reviewed literature59 and in their technique text book60 the CBP® approach to managing the pregnant patient. For Allen Botnick, DC to state otherwise is entirely inaccurate.

2) Concerning obesity or body mass index (BMI), in their spinal biomechanics text, Harrison, Harrison and Haas,61 present an updated elliptical model of the thoracic and lumbar sagittal curvatures. Here, the lumbar elliptical minor/major axis ratio (b/a) was shown to be .32 compared to their earlier study of .39.62 Part of the reason for the difference in the b/a ratio is due to several overweight subjects in their previous manuscript.62 Thus, CBP® has shown that increasing BMI causes a more circular lumbar lordosis. Therefore, I assert that CBP® is well aware of this issue and it is Allen Botnick’s ignorance of CBP® research and his own lack of understanding that causes him to fabricate these statements.

3) The foot pronation idea has already been addressed under item B above.

4) The muscle shortening statement is complete conjecture made up by Botnick and the torn ligament notion would be detected in an appropriate x-ray analysis that most of us DC’s (including CBP®’ers) learn in Chiropractic college.

5) The malformation of vertebra statement has been addressed under item D and blocked vertebral anomalies have been addressed by Harrison, Harrison, and Haas in the CBP® Cervical Rehab Book, Chapter 3.63

Aside from true wedge shaped scoliotic vertebra, I could locate Zero support for Allen Botnick’s statements. For suggested support of his conjectures, Allen Botnick, DC refers to Haas et al., but Haas et al. presented no data to support that spinous process asymmetry causes known changes in spinal alignment. In fact, these statements by Haas et al were rebutted by me and CBP® researchers previously.5 Instead of offering his rampant personal opinions and opinion papers by others how about some real evidence. Where’s your data Botnick?

59. Troyanovich SJ. Chiropractic approach to exercise for the pregnant patient. Chiropr Tech 1993;5(2):56-59.
60. Harrison DD. CBP®â Technique: The Physics of Spinal Correction. National Library of Medicine #WE 725 4318C, 1982-97.
61. Harrison DE, Harrison DD, Haas JW. Spinal Biomechanics for Clinicians. Volume 1. Harrison CBP® Seminars, Inc., Evanston, WY. 2003; page 41.
62. Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE. Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects. J Spinal Disord 1998;11(5):430-439.
63. Harrison DE, Harrison DD, Haas JW. CBP®, Structural Rehabilitation of the Cervical Spine. Harrison CBP® Seminars, Inc., Evanston, WY. 2002; page 62.

N) Dr. Botnick claims that “CBP®’s inclusion in chiropractic curriculums violates the Council on Chiropractic’s Education’s standards…” I suggest that this statement could have legal ramifications not only by CBP® Technique but also by the colleges that offer CBP® as an elective and core curriculum as part of Chiropractic Education. Allen Botnick, DC only offers his opinion, he does not represent the CCE’s position on this matter, and does not sit on any board that approves such techniques in chiropractic college curricula. Thus he carries no authority to make this statement. In my opinion, only a vindictive and biased individual would make these types of statements without facts and proper citations.

Conclusions

Allen Botnick DC’s, criticisms of CBP® technique are not supported by legitimate scientific evidence. Only his personal opinion and those opinions of a few fringe Chiropractors are provided to claim CBP® Technique has reliability and validity concerns. In fact, Allen Botnick has not brought forth any information that CBP® Researchers have not already addressed through their scientific publications and text books. The non-discriminate reader (in particular an unwary patient) is left with the opinions of a fringe chiropractor. Allen Botnick, DC has never published a single scientific manuscript in the peer-reviewed literature, has never participated in an expert panel for guidelines, and does not sit on any board nor does he review for a single scientific journal. In short, no credible scientist would give him a second look or listen—so why should I: Because of the extreme confusion that he has created for CBP® Patients and outright fabrications he has made in a public forum.

While Chiropractic has continued to combat public image problems, I wonder why a DC, would be associated with long time Chiropractic critic, Dr. Barrett, MD? And for Dr. Barrett to allow an article of this poor quality to be written by a Chiropractor (Allen Botnick) with no scientific authority/caliber is very suspect. Dr. Barrett has given his forum to and helped create an “Internet Expert” in the Chiropractic profession. Try doing an actual author search in the scientific literature on Allen Botnick, DC and you will find emptiness.
Lastly, after reading my rebuttal, if Dr. Barrett is an honest person and a true “scientist”, he will remove the unsupported CBP® attack by Allen Botnick, DC from his web site.

In the name of science,
Deed E. Harrison, DC
President, Chiropractic BioPhysics Technique and Seminars