What is Subluxation?

With each passing year the practise of chiropractic is becoming more and more evidence-based.  There was a time when, although we knew it worked, we just could not point to any valid research.  Now as well as numerous outcome-based case studies, and RCTs, there is in vivo research which shows the effect of the chiropractic adjustment.

Chiropractic is based around the concept of a ‘subluxation’, first described by Palmer, 1910 as “the result of insult(s) to the nervous system caused by any one or a combination of physical trauma, chemical irritants or ‘mental’ (emotional) stresses”, [Davies, 2000].

This has become developed as the ‘Vertebral Subluxation Complex’ by Faye, consisting of five components: kinesiopathology, histopathology, neuropathology, myopathology and biochemical abnormalities, [Dishman, 1985]; [Dishman, 1988]; and the further by [Lantz, 1995], [Anrig & Plaugher, 1998], and the term ‘VSC’ is used by the Association of Chiropractic Colleges (ACC).

“The development of the VSC is distinctively chiropractic and reflects in a unique way the clinical practice of chiropractic. Common to all concepts of subluxation are some form of kinesiological dysfunction and some form of neurologic involvement. The VSC addresses the issues of chiropractic in a uniquely chiropractic way but is also understandable to any other interested party.” [Lantz, 1995].

The ACC states that:

"Chiropractic is a health care discipline which emphasizes the inherent recuperative power of the body to heal itself without the use of drugs or surgery.

The practice of chiropractic focuses on the relationship between structure (primarily the spine) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health." [WORLDCHIROPRACTICALLIANCE].

Siblings, for example, whilst living in a similar environment, have succumbed to differing physical traumas, chemical traumas and irritants, and emotional factors. Any of these may result in subluxations in varying degrees. The subluxations will have had a neurological effect and for one brother, this may have an influence on his respiratory system and maybe his ears. It may be the reason for a lowered immunity to infection. The relationship between the nervous system and the immune system has been the topic of research and publication,

[Davies 2000, Brooks et al, 1982, Gatterman, 1990, 1995].

Due diligence must be given when taking the Case History to determine the possible causes of subluxation and in examination to determine the resultant subluxations and their compensations. Compensations will normally show as being hypermobile as opposed to hypomobile subluxations, as taught by Clarence Gonstead.

[Plaugher, Lopes,1992].

Stephenson also states the “Rule-Never adjust for adaptive conditions; adjust for the primary condition that produces them”

[Stephenson, 1948].

Neil Davies writes:

 “It is not axiomatic that consistently accurate clinical decisions are irrevocably intertwined with the understanding that the subluxation is not a random, unpredictable biomechanical event, but rather, a neuropathalogical state which exhibits multifaceted, measurable manifestations in the neuromusculoskeletal system which occurs in largely predictable patterns.

The role of the chiropractor, then, is not simply the mobilization of a ‘stuck joint’ as some have wrongly imagined, but the correction of patterns of functional neuropathy.”

[Davies, 2000].

Palmer's chiropractic was based on theories that the nervous system was continuous. However, Cajal's theories in the 1930s, proposed that the nervous system was contiguous. These theories became accepted much later and an adjustment is deemed to affect the neuronal pools, altering the probabilities of summation, rather than remove pressure from nerves.  In this way instantaneous results may be observed.

[Power, 1995].

Nerve regeneration takes time and damage caused by ‘pressure on the nerve’, and the subsequent removal of that pressure via chiropractic adjustment does not produce instantaneous nerve regeneration.
[Power,1995] The neural pools theory is thus very attractive.

Respiratory problems, for example, could be due to a subluxation at T2/T3 but might just as easily be due to a general depression of the immunological system from a subluxation elsewhere.  It is important to find the subluxation on the patient and not on a chart or X-ray; [Plaugher, Lopes, 1992].

The case history might show up multiple possible causes of subluxations from re-natal, peri-natal and post-natal and onwards.  Examination would show the current subluxation status. Adjustments to the primary subluxation, should produce instantaneous results, reflected to changes in reflexes and muscle strength.

There has been research into the immune system and chiropractic, for example, the following abstract:

An overview of neuroimmunomodulation and a possible correlation with musculoskeletal system function
There is an increasing body of evidence that the nervous system is capable of modulating the immune response. Receptors for neuromodulators and neurohormones have been found on human T lymphocytes. Activation of these receptors can be stimulatory or inhibitory depending on the neuroactive substance. The immune system may be able to communicate with the nervous system using neuromodulators and neurohormones secreted by lymphocytes. Sympathetic innervation of lymphoid tissues is not restricted to blood vessels and smooth muscle, but directly supplies lymphocytes and blood precursor cells. It is theorized that spinal fixations may adversely affect the immune response through somatosympathetic reflexes. Spinal manipulation can correct the spinal fixations and may eliminate the adverse affects of somatosympathetic reflexes. [Fidelibus, 1989].

The conclusion is that even siblings, whilst they are brothers and sisters and enjoy a similar family environment, have had a very different life history, resulting in a very different subluxation and hence neurological signature. It is therefore of no surprise that the levels of health within families can vary greatly.

References

Anrig CA, Plaugher G, eds. (1998), Pediatric Chiropractic., Williams & Wilkins

Brooks WH, Cross RJ, Roszman TL, Markesbery WR. (1982), Neuroimmunomodulation: Neural Anatomical Basis for Impairment and Facilitation. Annu Neurol 12:56-61.

Davies NJ., (2000), Chiropractic Pediatrics- A Clinical Handbook, Churchill Livingstone

Dishman, R. (1985) Review of the Literature Supporting a Scientific Basis for the Chiropractic Subluxation Complex. J Manipul & Physiol Therap, 8:163-174.

Dishman, R.W. (1988) Static and Dynamic Components of the Chiropractic Subluxation Complex: A Literature Review. J Manip Physiol Therap 11(2):98-107

Fidelibus, (1989), An Overview of Neuroimmunomodulation and a Possible Correlation with Musculoskeletal System Function , J Manipulative Physiol Ther. Aug;12(4):289-92.

Gatterman MI., (1990) Chiropractic Management of Spine Related Disorders. Williams & Wilkins, pp 40-49

Gatterman MI., (1995) Foundations of Chiropractic Subluxations, Mosby

Lantz CA., (1995) The vertebral subluxation complex. In Gatterman M (ed). Foundations of Chiropractic: Subluxation, Mosby;

Plaugher G, Lopes MA, eds. (1992) Textbook of Clinical Chiropractic: A Specific Biomechanical Approach, Williams & Wilkins

Power K, (1995) Neuron Theory - Module 1,University of South Florida

Stephenson RW., (1948) Chiropractic Textbook, Palmer School of Chiropractic.

Online References

4BASIC, (2002), What is a subluxation? http://www.4basicessentials.com/sublux.php

WORLDCHIROPRACTICALLIANCE, The ACC Chiropractic Paradigm http://www.worldchiropracticalliance.org/acc/diagram.htm