Vertebral subluxation

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The current chiropractic definition of a vertebral subluxation is "a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function 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".

A subluxation may affect one disc within the spine (degenerative disc disease) or a section of the spine, including the whole spine in some cases. For example, a functional scoliosis, viewed in chiropractic terms, may be due to a vertebral subluxation manifesting as an arch or abnormal curvature.

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

Modern chiropractic treatment focuses on treating the vertebral subluxation by delivering a chiropractic adjustment to the affected part of the spine to relieve the hindrance to nerve function. It should not be confused with the orthopedic subluxation.

Historical definitions

"The possible neurological consequences of subluxation were described by Harrison in 1821, as quoted by Terrett:“When any of the vertebrae become displaced or too prominent, the patient experiences inconvenience from a local derangement in the nerves of the part. He, in consequence, is tormented with a train of nervous symptoms, which are as obscure in their origin as they are stubborn in their nature...”"

In the chiropractic system developed by Daniel D. Palmer in the late 1800's, Palmer originally believed that he had discovered the cause of all diseases suffered by mankind - the vertebral subluxation.

"Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations which are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionating—too much or not enough action—which is disease."

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

Functional theory of vertebral subluxation

Vertebral subluxation
The formation of the spinal nerve from the dorsal and ventral roots
A spinal nerve with its anterior and posterior roots.
Details
Identifiers
Latin	radix posterior
Anatomical terminology[edit on Wikidata]

As a continuation of the brain, the spinal cord contains nerve tracts which are the neurological pathways thru which the brain communicates with most of the body. While the brain is protected by the skull, the spinal cord is protected by the vertebral column. As nerves branch off the spinal cord, they form the spinal nerve roots which exit the vertebral column thru an opening made by two adjacent vertebrae, called the Intervertebral foramen.

There are several hypotheses on how a misaligned vertebra can cause interferrence to the nervous system.

Nerve compression hypothesis: suggests that when the vertebrae are out of alignment, the nerve roots and/or spinal cord can become pinched or irritated. While the most commonly referenced hypothesis, and easiest for a patient to understand, it may be the least likely to occure.
Proprioceptive insult hypothesis: focuses on articular alterations causing hyperactivity of the sensory nerve fibers.
Somatosympathetic reflex hypothesis: all the visceral organ functions can be reflexly affected by cutaneous or muscular stimulation.
Somatosomatic reflex hypothesis: afferent impulses from one part of the body can result in reflex activity in other parts of the body.
Viscerosomatic reflex hypothesis: visceral afferent fibers cause reflex somatic problems.
Somatopsychic hypothesis: the effects of a subluxation on the ascending paths of the reticular activating system.
Neurodystrophic hypothesis: focuses on lowered tissue resistance that results from abnormal innervation.
Dentate ligament-cord distortion hypothesis: upper cervical misalignments can cause the dentate ligaments to put a stress on the spinal cord.
Psychogenic hypothesis: emotions, such as stress, causing contraction in skeletal muscles.

When the vertebral subluxation is viewed as a syndrome, the signs and/or symptoms are: altered alignment; aberrant motion; palpable soft tissue changes; localized/referred pain; muscle contraction or imbalance; altered physiological function; reversible with adjustment/manipulation; focal tenderness.

When used in this sense, the claims for the existence of vertebral subluxations are a matter of controversy, 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, and evidence that some chiropractors engaged in unscientific practices. The court did not reach the question of whether chiropractic theory was in fact scientific. However, the evidence in the case was that some forms of chiropractic manipulation of the spine and joints was therapeutic. AMA witnesses, including the present Chairman of the Board of Trustees of the AMA, testified that some forms of treatment by chiropractors, including manipulation, can be therapeutic in the treatment of conditions such as back pain syndrome.

In contrast, the orthopedic subluxation is any joint that has partially lost its normal position, regardless of whether this does or doesn't cause nerve interference.

Treatment of vertebral subluxation

If a Vertebral Subluxation is detected, a chiropractor applies a specific adjustment procedure to the spinal bone considered to be subluxated. While there are a number of different chiropractic techniques, they all can be characterized by the description of having a short-lever, high velocity, low amplitude, (HVLA) and specific line of correction. It could be said the one thing that seperates the chiropractic adjustment from other manipulative techniques is the aim toward specificity.

Once these bones or vertebrae are restored to their proper position, the spinal cord and/or its nerve roots are no longer hindered or compressed. Without interference from a subluxation, the brain can transmit and receive all the messages through the spinal cord and nerve roots to all the parts of the body supplied by those nerves. The spine is considered "in line" and thus the body functions in a coordinated manner resulting in increased health.

History

Vertebral subluxation is 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 was possibly 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.

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

Logical and Scientific Critique of Chiropractic Claims

Tedd Koren, D.C.'s causistry illustrates the root of the confusion. Despite his dismissal of theory, all science postulates hypotheses or theories to explain the workings of phenomena. True, we do not "see" gravity, because it is a theory; but the theory of gravity explains the phenomena we do see. Moreover, the phenomena are not merely observable, they are also quantifiable and predictive when interactive. Gravity, electromagnatism, relativity, chemistry, genes, germ theory, etc., are some of the myriad scientific theories that explain how certain known phenomena work and/or are related. When these hypotheses are repeatedly demonstrated and independently verified, they become theory. Since the 15th century, the scientific method is without doubt. (Consult any book on science.)

Chiropractic, however, does it precisely in reverse. Its theory postulates the existence of phenemona that no one else can find, much less verify. The "confusion" arises in locating the phenomena the theory purports to "exist." The abstraction of subluxation, as Koren admits, is a classic example. The subluxation is a theory for which no known phenomena correspond. That's why no one (except chiropractors) can observe, define, measure, or predict whatever "subluxations" might be. Chiropractors like Koren insist subluxations must exist, because their theory demands it. But it is backwards. Theories explain phenomena, not posit the existence of phenomena. Chiropractic is a theory, or set of theories, in search of phenomena. It's this mode of "reverse" thinking that provokes the confusion, indeed, consternation. (Ask to "see" what chiropractors claim.)

The same "reverse" thinking holds for nearly all of chiropractic's claims. "Neurological interference" is a theory for which no phenomena are known to correspond. Chiropractic's "adjustment" purports to treat a "phenomenon" that only chiropractors claim to "know." Indeed, no two chiropractors "know" the same thing. When examining the same patient sequentially and separately, and without input from each other, no two chiropractors come to the same conclusion. The "phenomena" chiropractors claim "exist" only do so in their minds, but not with any consensus among them. Positing a theory in search of phenomena is the reverse of science. Without phenemona, it is impossible to observe, quantity, or predict, much less evaluate for effectiveness, chiropractic claims.

This confusion does not mean chiropractic does not work. The problem with chiropractic is explaining "what" is involved, "how" it could work, if it does, and "why" anyone could benefit? Without phenomena, how would one anyone do this? Chiropractic theory seems coherent, even logical: Vertebrae misalign, causing neurological interference, resulting in disease, dysfunction, or illness. Chiropractors adjust the misaligned vertebrae, nerve impulses are restored, health regained. The confusion arises over the lack of phenomena that are supposed to exist according to the theory. Vertebrae exist, but not "vertebral subluxations." Nerves exist, but not "neurological interference." Disease exists, but not from neurological interference. Accordingly, the definition given for "subluxation" is amorphous, ambiguous, and obscure, but given a lack of actual phenomena, how could it be otherwise? The same problem pervades all chiropractic claims. Indeed, the entire "reverse" thinking is the cause of the confusion. (Consult the American Chiropractic and International Chiropractic Association and the plethora of Chiropractic Colleges for theory; evidence of the "phenomena" chiropractic claims has never been demonstrated to anyone.)

Despite enormous skepticism from the scientific medical community, many patients swear by chiropractic manipulation. But Medicare and insurance companies are increasingly weary of providing reimbursement (a maximum of 12 payments of no more than $25 each). Confusion arises over what insurance plans and patients are paying for. Without measurable phenomena, chiropractic's claims simply cannot be determined, much less explained, much less justified. (see, Medicare, Blue Cross, Blue Shield, Aetna, "Terms of Use" etc.)

Just because chiropractic began as "faith healing," does not mean it still is. Still, how does one evaluate theoretical claims without measurable phenomena? Without phenomena, there simply is nothing to observe; without observation there is no evidence; and without evidence what is one to evaluate? Subluxation proponents ask us to accept chiropractic on faith. (D. S. Heersink.)

References

Palmer DD (1910) The Science, Art and Philosophy of Chiropractic Portland, Oregon: Portland Printing House Company p20
Strang,V (1984) Essential Principles of Chiropractic Davenport : Palmer College of Chiropractic, OCLC: 12102972

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

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