If you have spent any time in my Chiropractic office, you may have heard and or seen on the wall this phrase:
Above Down Inside Out.
For many patients, this sounds interesting, but also a little abstract. What does it actually mean? And how is it different from the way most healthcare is practiced today?
This difference in thinking is coined The Great Divide by BJ Palmer, the son of the founder of Chiropractic.
Understanding it can completely change how you view your body, healing, and the role of Chiropractic care.
What Is the Great Divide?
The Great Divide refers to two fundamentally different ways of understanding health, healing, and the human body.
These two perspectives are:
- Outside In (Sick Care)
- Above Down Inside Out (Health Care)
Neither side is about good versus bad people. It is about where healing is believed to originate.
Once you see the difference, you cannot unsee it.
Outside In Thinking
This is the current dominant “Healthcare” model, which I would deem to be more appropriately named: Sick Care.
In this model, health is managed by altering the body’s response to its environmental stressful situation by changing its chemistry from the outside in.
Examples include:
Medications to reduce symptoms
Injections to block pain
Surgery to remove or mend damaged tissue
The underlying assumption is that the body is either broken or incapable of restoring itself without external intervention.
This model can be lifesaving in trauma, infection, and emergency situations.
I’ve heard this analogy before from Dr. James Chestnut that I hope you find helpful to explain this further:
Firefighters are great at putting out the house that is on fire.
Does putting the fire out cause damage to the house?
Yes. But at least it saved it.
Now that the fire is out, do you have the firefighters build the house back up?
No! That would be ridiculous. You would hire carpenters.
I encourage you to consider this analogy with the way medicine and the medical system is used.
Outside In care often focuses on managing symptoms rather than restoring function. Relief may occur, but the root cause is not addressed.
Let me ask you these questions:
- When you have a fever, is your body failing you, or is it responding perfectly well to an environmental stressor?
- When you vomit, is your body malfunctioning, or is it responding perfectly well to an environmental stressor?
What about in this situation:
c. When your body’s blood pressure goes up, is your body malfunctioning, or is it responding perfectly well to an environmental stressor?
Next Question:
What’s the best way to resolve the symptoms above?
Put something in your body to change the chemistry so that the:
- fever goes down?
- You stop vomiting?
- your blood pressure goes down?
Or,
Consider what in your environment is causing your body to respond to the environment the way that it is, and make changes to the environment.
- Support your body’s immune system with sleep, rest, good nutrition, removing yourself from stress
- Same as above
- same as above, plus things your body needs to be healthy: avoid toxic load (chemical, physical, and emotional), and provide it what it needs (real food, movement/exercise, love/community)
Above Down Inside Out Thinking
A Health Care Model, inline with Chiropractic perspective
Above Down Inside Out thinking starts from a very different place.
It recognizes that the body is self regulating and self healing by design.
Healing originates inside the body and is coordinated by the nervous system, which flows from the brain down the spinal cord and out to every tissue, organ, and cell.
In this model:
The brain directs function
The nervous system coordinates healing
The body adapts and repairs when interference is reduced
Chiropractic care does not add healing to the body.
It removes interference so the healing already built into the body can express itself more fully.
Why the Nervous System Matters
Your nervous system controls everything.
Movement
Balance
Digestion
Immune response
Hormone regulation
Healing and tissue repair
When spinal motion is restricted or joint mechanics are altered, it can affect how well the nervous system communicates.
Chiropractic adjustments aim to restore motion and reduce stress on the nervous system so the body can better coordinate itself.
This is an Above Down Inside Out approach.
Why This Matters for Long Term Health
Outside In care often answers the question:
How do we make this symptom stop?
Above Down Inside Out care asks:
Why is the body adapting this way? What’s going on with the environment to cause this symptom?
This shift in thinking explains why Chiropractic care often continues beyond pain relief. Pain is only one signal. Function is the bigger picture.
Many patients feel better before their body is actually functioning better.
Feeling Better vs Functioning Better
One of the biggest misunderstandings in healthcare is assuming that symptom relief equals healing is complete.
Pain can decrease even while underlying dysfunction remains.
Above Down Inside Out care prioritizes restoring function first, knowing that symptoms often resolve as a result, not as the primary goal.
This is also why continued Chiropractic care is often recommended even when pain improves.
The goal is not just relief. The goal is resilience.
Chiropractic helps your body be more resilient to life’s stressors.
This means you can handle more before your body falls apart.
Where Each Model Fits
This is not an either or argument.
Outside In care is essential for medical emergencies.
Above Down Inside Out care is essential for optimizing function, adaptation, and long term health.
The problem arises when Outside In care is the only model considered; especially for restoring health.
Also, the reality is that most medical concerns people have are not life and death medical emergencies. They are Chronic health issues as a result of poor lifestyle choices. They are your body’s adaptation to the stressful environment you’ve surrounded yourself with.
But here’s the thing: if you let the Chronic issues go on too long – they will become a medical emergency!
The Chiropractic Choice
Chiropractic exists on the Above Down Inside Out side of The Great Divide.
It is based on the understanding that:
The body heals itself
The nervous system coordinates that healing
Spinal function influences nervous system performance
When interference is reduced, the body often does what it has always been capable of doing.
The Bottom Line
The Great Divide is about understanding where healing comes from.
Above Down Inside Out thinking trusts the body’s innate ability to adapt and heal when properly supported.
Outside In thinking relies on external solutions to manage problems.
Chiropractic care is built on the belief that the power that made the body heals the body.
Our role is simply to help remove what is in the way.
Author
Dr. Nik Dukovac, B.Sc., D.C.
Chiropractor | Fairway Chiropractic CentreDr. Nik Dukovac is a Chiropractor serving the Kitchener Waterloo Cambridge community, focused on restoring spinal function, supporting nervous system health, and helping patients understand how their bodies are designed to heal from an Above Down Inside Out perspective.