Vertebral subluxation: Difference between revisions

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Modern definition

The current chiropractic definition of a vertebral subluxation is defined as "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and/or influence organ system and general health", or "a condition in which a vertebra has lost its proper juxtaposition with an adjacent vertebra (to an extent less than a luxation) in such a way as to alter nerve function".

Subluxation may affect one disc within the spine (vertebral prolapse, or 'slipped disc') or a section of the spine, including the whole spine in some cases. For example scoliosis, viewed in chiropractic terms, is a form of vertebral subluxation manifesting as an arch or abnormal curvature of the spine which affects the transmission of nerve impulses.

Chiropractors claim that this condition negatively affects the general health of the body by reducing the proper circulation of either or both the autonomic and somatic nervous system, depending on the degree of subluxation and its location. Although not always painful, the subluxation interferes with proper function and healing of your body.

Vertebal subluxation is also considered to lead to somatic (not congenital) malformation of the spinal column, similar to osteoarthritis. Chiropractic views of spinal osetoarthritis and bone spurs or vertebral malformations as caused by a form of neural feedback and reaction of spinal bone growth to the irritation caused by the vertebral subluxation. Chirorpactic claims to have reduced, relieved or cured such spinal malformations by proper readjustment of the spinal column, to allow the body to heal the bone malformation.

Modern chiropractic treatment aims to treat vertebral subluxation by 'chiropractic adjustment' of the spine to relieve the hindrance to nerve function. Most modern chiropractic practitioners do not claim chiropractic can cure all manner of ills, but do cite studies and evidence claiming that chiropractic treatment of vertebral subluxation is has proven efficacy in relief of a wide range of symptoms and health issues, including;

Back, neck and musculo-skeletal soreness and stiffness
Scoliosis and realignment of abnormal curvature of the spine
Alleviation of some spinal malformations considered to be caused by vertebral subluxation
Improvement in bowel, bladder and digestive function
Improvement in menstrual regularity and severity of menstrual cramps or bleeding
Improvements in eyesight, hearing and mentual acuity in some cases
Improvement in general feeling of health, well-being and vitality

Historical definitions

In the chiropractic system developed by Daniel D. Palmer in the late 1800s, Palmer believed that he had discovered the cause of all diseases suffered by mankind - the vertebral subluxation. It should not be confused with the orthopedic subluxation.

Chiropractors use and have used various terms to express this concept: subluxation, vertebral subluxation (VS), vertebral subluxation complex (VSC), "killer subluxations," the "silent killer," "bone out of place" (BOOP), etc.

Functional theory of vertebral subluxation

The spinal cord holds 120 trillion nerve tracts. These tracts are the neurological pathways by which the brain communicates with the entire body. The nerve axial pathways exist the spinal column between the vertebral discs and the flanges of the vertebrae.

Chiropractic medicine holds that when the vertebrae are out of alignment or prolapsed, the transverse neurones become pinched, which cause interference with nervous transmissions. When pressure is on the spinal nerves, the message from the brain cannot get to the tissue or organs as intended, or in reduced efficiency and the result is malfunction, disease and eventual death to the organ(s) or area(s) lacking supply.

When used in this sense, the claims for the existence of vertebral "subluxations" are a matter of controversy and confusion, and the chiropractic concept is not recognized by mainstream medicine. The Wilk v. American Medical Association trial transcripts mention this fact:

There was evidence that the chiropractic theory of subluxations was unscientific...

By contrast, the existence of the orthopedic subluxation is recognized by all parties, including chiropractors.

Diagnosis of vertebral subluxation

Chiropractic diagnosis of vertebral subluxation is made by performing an interrogation of the patients general health and lifestyle for symptoms, performing a neurological function assessment including testing of reflexes and nerve function, and assessing the flexibility and mobility of the patient for signs of impaired musculo-skeletal function.

The interrogation of general symptoms focuses on;

Assessing the patients view of their own health
Identifying symptomatic problems considered by chiropractic as indicative of subluxation
Querying the patient about their health concerns

Neurological function is assessed by;

Quantitatively comparing muscle strength of limbs (eg; strength of left vs right arms) to identify imbalance in function
Comparing reflexive resonse of the patient's limbs to identify imbalance of nerve function
Qualitatively comparing tactile sensations reported by the patient (using spurs or tactile stimulation)
Assessing patient's balance and coordination

Flexibility and mobility is assessed by;

Comparing the angular rotation exhibited by the neck, mid back and lower back to identify imbalance of function
Assessing flexibility of the spine via bending and stretching exercises

Indications of vertebral subluxation are identified if the patient exhibits imbalanced or reduced function in these areas. In most cases these tests are performed before radiology is used to image the spine and confirm or deny the presnce of a vertebral subluxation.

Treatment of vertebral subluxation

If a Vertebral Subluxation is detected, a chiropractor applies a specific adjustment procedure to the bones surrounding the spinal cord. Once these bones or vertebrae are restored to their proper position, the spinal cord and its nerve tracts are no longer hindered or compressed. Without "spinal cord pressure" the brain can transmit all messages through the spinal cord and over the nervous system to all organs and systems with a natural ease. The spine is simply in line and thus the body functions as it should in health.

The controversy surrounding chiropractic can be boiled down to a demarcation dispute between chiropractic and the orthodox medical profession.

Chiropractic sees the body as a functional self-regulating and self-healing natural system, and emphasises restoring function to the body via allowing unhindered nerve impulses. The philosophy of chiropractic is to return mobility and flexibility and function via emphasising the self-healing powers of the human body, usually via treatment of vertebral subluxation in combination ith diet, exercise, postural and mechanical awareness and stress mnagement.

This is at odds with the orthodox medical profession which assesses and treats symptoms of illness as diseases which can be cured by individual, specific treatments using drugs or at times, surgery. The orthodox medical profession has accused chiropractic of being unfounded and unscientific pseudoscience.

The difference is best illustrated by comparison. A patient who suffers diarrhoea, incontinence, back pains and weak musculature would present to the orthodox medical profession as suffering from some infection of the gut and would be treated with antibiotics. Chiropractic would assess this grouping of symptoms as indicative of a possible vertebral subluxation.

History

Vertebral subluxations are a concept that evolved over decades of research conducted in the chiropractic, osteopathic and medical professions. The term was borrowed from medical literature to designate a disruption of normal nerve activity, theorized to be at the source of noticeable changes in the body. Contrary to assertions (see below), the concept of subluxation is not solely an invention of the chiropractic profession. There are historical references going back to Hippocrates to support the long held belief and clinical impression that function of spine was a key element in the proper maintenance of health.

In its chiropractic context, the term "subluxation" was first described by Daniel David Palmer, who likely was inspired by osteopath Andrew Still. Still's model was a disturbance of blood flow to various organs from "osteopathic lesions", resulting in weakening of tissues and organs. Palmer's understanding, based on the scientific knowledge of the time, was that a disturbance of nerve supplies to the same tissues and organs more readily explained the changes produced after correction ("adjustments") of misaligned spinal bones.

The original investigation and research into this newly described entity are shrouded in confusion, due to lack of formal notes, and the political struggle that ensued to establish a stable fountainhead for the entire chiropractic profession. A popular version was that Palmer restored long-lost hearing to a janitor by realigning bones of his spine. Sources from the period claim that chiropractic as a treatment form gained notoriety during the 1918 Flu Epidemic, when it was found that patients receiving "adjustments" had significant lesser mortality than those treated with conventional medical treatments of the day. The impact of subluxation on the immune system has been researched and demonstrated well into the 1980's by other researchers including Ronald Pero, head of the Cancer Prevention Institute in New York.

The search for subluxations has led to one of the most significant contributions of the chiropractic profession to the health sciences: radiography. In an attempt to visualize and analyze spinal misalignment, chiropractors embraced and provided initial interest in an emergent technology that used radiation from a high voltage emitter to produce a shadow of dense bone tissue on light sensitive plates. This allowed the establishment of a stable network of suppliers for hardware, films and chemicals that are now widely used by medical science. Nowadays, xray analysis still provides diagnostic and analytic information to chiropractors.

Further osteopathic researchers, like Irwin Korr, investigated and confirmed the influence of nerve involvement in the mechanism of health and disease influenced by osteopathic and chiropractic treatments. However, over the years, the osteopathic and chiropractic professions have diverged in their scope and focus. Whereas chiropractors have retained as their main goal the detection and correction of subluxations, osteopathic education and practice has shifted away toward a more medical, drug and surgery dependent approach to care.

Other medical researchers, like Maigne, a French rheumatologist, have found that spinal bones that displayed normal position but moved abnormally were also producing abnormal changes to tissues away from the spine. While his attention was paid to muscles, bones and ligaments affected by motor nerves, Maigne provided no reason why the same sort of changes could not also affect internal tissues and organs affected by "autonomic" nerves originating from the same spinal segments.

The modern chiropractic profession

Nowadays, the profession is divided into 2 models: one which questions the validity of subluxations as a demonstrable scientific concept, and favours a strictly musculo-skeletal approach to the treatment of back, neck and joint pain. The other model recognizes that for all the inherent difficulties in investigation of subluxations (which like psychoanalysts' neuroses and acupuncturists' meridians do not readily lend themselves to objective scrutiny), the concept is as close as the profession has come to explain the observable impact chiropractic treatments have had on a number of conditions seemingly unrelated to the spine, such as asthma, colics in babies, CD4 cell production in AIDS patients and migraines.

Controversial aspects of chiropractic theories

Daniel D. Palmer held that certain dislocations of bones interfere with the "innate intelligence", a kind of spiritual energy dependent upon God that connects the brain to the rest of the body.

Over time, a small but growing number of adherents to chiropractic theory gave up on the idea of "innate intelligence", but still held that spinal bone misalignments were the cause of all or most disease. Some practitioners of Chiropractic health care claim to be able to see these subluxations on X-rays.

By the 1970s the Palmer school began to deny that subluxations could even be seen on X-rays; other chiropractors still hold that they can be seen on X-rays.

In the mid 1990s the Association of Chiropractic Colleges redefined a subluxation as follows: "A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and/or influence organ system and general health." Some critics declare that this defines almost anything as a subluxation.

In 1997 the Foundation for Chiropractic Education and Research redefined a subluxation as "a joint problem (whether a problem with the way the joint is functioning, a physical problem with the joint, or a combination of any of these) that affects the function of nerves and therefore affect the body's organs and general health."

The controversy surrounding chiropractic can be boiled down to a demarcation dispute between chiropractic and the orthodox medical profession.

The difference is best illustrated by comparison. A patient who suffers diarrhoea, inconinence, back pains and weak musculature would present to the orthodox medical profession as suffering from some infection of the gut and would be treated with antibiotics. Chiropractic would assess this grouping of symptoms as indicative of a possible vertebral subluxation.

Sources of confusion

Defining the concept of vertebral subluxation has been plagued with problems since its inception. One of chiropractic's most staunch defenders of belief in the Vertebral subluxation provides this explanation as a possible cause of the confusion:

The vertebral subluxation cannot be precisely defined because it is an abstraction, an intellectual construct used by chiropractors, chiropractic researchers, educators and others to explain the success of the chiropractic adjustment.

This is not a unique state of affairs, abstract entities populate many branches of science...

Subluxations, genes, gravity, the ego and life are all heuristic devices, "useful fictions" that are used to explain phenomenon that are far larger than our understanding. We use them as long as they work for us and discard or limit their application when they become unwieldy or unable to account for new observations...

Critics of chiropractic have incorrectly assumed that chiropractic is based on the theory or principle that vertebral subluxations cause "pinched" nerves that cause disease. They have it backwards. Chiropractic is based on the success of the spinal adjustment. The theory attempting to explain the success of the adjustment (nerve impingement, dis-ease, subluxations) followed its clinical discovery.

Examples of such erroneous criticisms based on this straw-man argument abound in the medical literature. Some examples: "The teachers, research workers and practitioners of medicine reject the so-called principle on which chiropractic is based and correctly and bluntly label it a fraud and hoax on the human race." "The basis of chiropractic is completely unscientific." The theory on which chiropractic is based , namely that a "subluxation" of a spinal vertebra presses on a nerve interfering with the passage of energy down that nerve causing disease to organs supplied by that nerve, and that chiropractic "adjustments" can alleviate the pressure thereby treating or preventing such disease.there is no scientific evidence for the validity of this theory."

To be fair, statements by some chiropractors have tended to perpetuate this misunderstanding: "Pressure on nerves causes irritation and tension with deranged functions as a result."

When chiropractors declare that "pinched nerves" "nerve impingement" "spinal fixations" or others mechanisms of action explain how subluxations affect the person and how chiropractic works they are making the same mistake medical critics make - assuming chiropractic is based on theory. Mechanisms and theories are useful tools, but their limitations should always be kept in mind. - Koren

References

References and peer-reviewed journal articles supporting, defining or questioning chiropractic are required

Chiropractic Journal of Australia

External links

Journal of Vertebral Subluxation Research - A Peer-Reviewed Scientific Journal
Chiropractic's Elusive Subluxation - Article by Stephen Barrett, M.D.
Does the Vertebral Subluxation Exist? - Article by Tedd Koren, DC
Exam and Code of Conduct for Chiropractors, New South Wales Health Department, Australia
Chiropractic FAQ
Ethical standards for Chiropractors, Australian Chiropractic Association

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