Now that the second decade of the second millennium is upon us, along with the prospect of spring cleaning, it seems entirely appropriate to consider that perhaps the time has arrived to update both our conceptualization and exposition of the subluxation.
The term subluxation suggests a lesser disorder than luxation, which in medical terminology historically designates a dislocation. In the early days of chiropractic, this commonly made reference to a bone and was usually relegated to the spine. However, some 40 years of clinical and basic research have refined the definition to the point at which a consensus statement has been reached, as follows:
"A complex of functional and/or structural and/or pathological changes that compromise neural integrity and may influence organ system's function and general health."1
The essence of subluxations is that they should be considered to be more subtle derangements. They may yet occur as misalignments rather than outright dislocations, but these may not be detectable by current technological methods. A more reliable yardstick to chiropractors is that they represent aberrations of movement integrity(either deficient or excessive motion), but reliable measurements of motion remain elusive. I have preferred to consider them to be physiologic dysfunctions, which may be present with or without pain.2,3 It is also entirely conceivable that subluxations may be detected by muscular inhibition or facilitation, as proposed in theories of applied kinesiology4,5 and supported by preliminary research.6-8
The definition pertaining to physiologic dysfunctions may facilitate our understanding of subluxations, which in my opinion are not necessarily confined to the spine at all. They could represent localized inflammations or nutritional deficiencies, as well as the more traditional vertebral irregularities as historically envisioned by chiropractic. All are intended to emphasize the importance of incipient, sometimes subclinical problems that are often capable of being resolved by early interventions that eliminate the need for more invasive and extended procedures eventually necessitated if such problems are allowed to fester and grow unchecked. The manner in which these early interventions are conducted may involve manipulation, exercise, nutritional advice, homeopathy, the use of herbs and/or supplements, or various aspects of mind-body medicine - all intended to precede the use of drugs or surgery, which would be indicated if time did not permit or if the earlier therapies were found to be ineffective.
Some of the more blatant manifestations featuring associated symptoms of a subluxation include cervicogenic headache, whiplash injuries, cervicogenic dorsalgia, thoracic subluxation syndrome, costovertebral subluxation syndrome, posterior joint facet syndrome, intervertebral disc syndrome, and sacroiliac joint syndrome.9
A leading traditional concept of subluxation held by chiropractors, the occurrence of joint fixations (not to be confused with dislocations), has been amply supported with recent animal model research. Here it can clearly be seen that degeneration of various structures of the spine (vertebral bodies, intervertebral disks, zygapophyseal joint articular surfaces) follows if joints of the spine are locked into fixation.10 The fact that spinal stiffness remains after the removal of the experimental links applied to produce this condition tells us that this aberration has produced a modification of the spinal and paraspinal tissues, moving from what was an acute condition into a chronic one. Such has been offered to be a representative model of the subluxation.11
But at the same time, we need to look beyond the spine. If a chiropractor were to adjust the extremities without spinal manipulation - for example, relieving compression upon the median nerve in treating carpal tunnel syndrome - how could the older definitions of the subluxation apply, particularly if they were confined to the spine? If nutritional concepts with or without managing stress - two major determinants of health - were to be advocated, how could one apply traditional concepts of subluxation?
One approach would be to consider irregularities of afferentation as the overarching principle, which could be brought on by structural derangements, inflammations, nutritional and absorption problems, hormonal imbalances, and emotional states (not the least of which is stress). At the end of the day, this may not be such an alien principle to chiropractic, since the earliest references to subluxations described them as a loss of tone.
As functional neurologists, therefore, chiropractors should be guided by those diagnostic tools best suited to disclosing how communications within the nervous system have become disrupted and ultimately lead to more traditional anatomic pathologies. Bony fixations to the exclusion of everything else (and particularly confined to the spine) just seem, well, too ossified. Hopefully, concepts such as these will help lead chiropractic into a more meaningful and less isolated position in 21st century health care.
References
- Association of Chiropractic Colleges, July 1996.
- Rosner AL. The Role of Subluxation in Chiropractic. Des Moines, IA: Foundation for Chiropractic Education and Research, 1997.
- Gatterman MI, Hansen D. Development of chiropractic nomenclature through consensus.Journal of Manipulative and Physiological Therapeutics, 1994;17:302-309.
- Goodheart GJ. Applied kinesiology research manuals. Detroit, MI. Previously published, 1964-1998.
- Walther DS. Applied Kinesiology Synopsis, 2nd Edition. ICAK-U.S.A.: Shawnee Mission, KS, 2009.
- Cuthbert SC, Goodheart GJ Jr. On the reliability and validity of manual muscle testing: a literature review. Chiropractic & Osteopathy, 2007;15(1):4.
- Stokes M, Young A. Investigations of quadriceps inhibition: implications for clinical practice. Physiotherapy, 1984;70:425-428.
- Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. Spine, 1996;21:2640-2650.
- Gatterman MI. Foundations of Chiropractic Subluxation, 2nd Edition. St. Louis, MO: Elsevier Mosby: 8, 557-562.
- Cramer GD, Fournier JT, Henderson CNR, Wolcott CC. Degenerative changes following spinal fixation in a small animal model. Journal of Manipulative and Physiological Therapeutics, 2004;27(3):141-154.
- Henderson CNR, Cramer GD, Zhang Q, DeVocht JW, Fourneir JT. Introducing the external link model for studying spine fixation and misalignment: Part 2: biomechanical features. Journal of Manipulative and Physiological Therapeutics, 2007;30(4):279-294.
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