Vertebral subluxation


In chiropractic, a vertebral subluxation means pressure on nerves, abnormal functions creating a lesion in some portion of the body, either in its action or makeup. Chiropractors claim subluxations are not necessarily visible on X-rays.
Straight chiropractors continue to follow Palmer's tradition, claiming that vertebral subluxation has considerable health effects and also adding a visceral component to the definition. Most medical experts and some mixer chiropractors consider these ideas to be pseudoscientific and dispute these claims, as there is no scientific evidence for the existence of chiropractic subluxations or proof they or their treatment have any effects on health.
The use of the word vertebral subluxation should not be confused with the term's precise usage in medicine, which considers only the anatomical relationships.
According to the World Health Organization, a chiropractic subluxation is a "dysfunction in a joint or motion segment in which alignment, movement integrity, and/or physiological function are altered, although contact between joint surfaces remains intact". The WHO notes that this is "different from the current medical definition" of a subluxation, which is a "structural displacement" significant enough to be "visible on static imaging studies" such as X-rays. Chiropractic is a field of alternative treatment outside scientific mainstream medicine, whose practitioners are not medical doctors.

History

In 1910, D.D. Palmer, the founder of chiropractic, wrote:
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 dis-ease.
In 1909, D.D. Palmer's son, B.J. Palmer, incorrectly claimed that chiropractic subluxation caused contagious diseases, writing:
Chiropractors have found in every disease that is supposed to be contagious, a cause in the spine. In the spinal column we will find a subluxation that corresponds to every type of disease. If we had one hundred cases of small-pox, I can prove to you where, in one, you will find a subluxation and you will find the same conditions in the other ninety-nine. I adjust one and return his functions to normal.... There is no contagious disease.... There is no infection.... There is a cause internal to man that makes of his body in a certain spot, more or less a breeding ground . It is a place where they can multiply, propagate, and then because they become so many they are classed as a cause.

Clinical practice

Definitions

Chiropractors use and have used various terms to express this concept: subluxation, vertebral subluxation, vertebral subluxation complex, "killer subluxations", and the "silent killer".
Chiropractors along with some physical therapists and osteopathic physicians, have also used another term, BOOP, meaning "bone out of place".
The WHO definition of the chiropractic vertebral subluxation is:
A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.
The purported displacement is not necessarily visible on static imaging studies, such as X-rays. This is in contrast to the medical definition of spinal subluxation which, according to the WHO, is a "significant structural displacement", and therefore visible on X-rays.
As of 2014, the National Board of Chiropractic Examiners states:
In 1996 an official consensus definition of subluxation was formed. Cooperstein and Gleberzon have described the situation: "... although many in the chiropractic profession reject the concept of "subluxation" and shun the use of this term as a diagnosis, the presidents of at least a dozen chiropractic colleges of the Association of Chiropractic Colleges developed a consensus definition of "subluxation" in 1996. It reads:
In 2001 the World Federation of Chiropractic, representing the national chiropractic associations in 77 countries, adopted this consensus statement which reaffirms belief in the vertebral subluxation.
The ACC paradigm has been criticized by chiropractic authors:
All in all, the ambiguities that permeate the ACC's statements on subluxation render it inadequate as a guide to clinical research... Whether the ACC's subluxation claims have succeeded as a political statement is beyond our concern here. These assertions were published as a priori truths, and are exemplary of scientifically unjustified assertions made in many corners of the profession. It matters not whether unsubstantiated assertions are offered for clinical, political, scientific, educational, marketing or other purposes; when offered without acknowledgment of their tentative character, they amount to dogmatism. We contend that attempts to foster unity at the expense of scientific integrity is ultimately self-defeating. To be sure, the profession's lack of cultural authority is based in part upon our characteristic disunity. However, attempts to generate unity by adoption of a common dogma can only bring scorn and continued alienation from the wider health care community and the public we all serve.
In May 2010 the General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, issued guidance for chiropractors stating that the chiropractic vertebral subluxation complex "is an historical concept" and "is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns."
The chiropractic vertebral subluxation complex has been a source of controversy since its inception in 1895 due to the lack of empirical evidence for its existence, its metaphysical origins, and claims of its far reaching effects on health and disease. Although some chiropractic associations and colleges support the concept of subluxation, many in the chiropractic profession reject it and shun the use of this term as a diagnosis. In the United States and in Canada the term nonallopathic lesion may be used in place of subluxation.
Other chiropractors consider subluxation as more of an abstract concept rather than a medical condition. Tedd Koren says,

International Classification of Diseases coding

The differences between a medical subluxation and a chiropractic "vertebral subluxation" create confusion and difficulties when it comes to following official ICD-9 and ICD-10 coding. In a 2014 article in Dynamic Chiropractic by a chiropractor who is a certified professional coder, these difficulties were discussed in detail. He noted that the WHO recognizes the differences between the two types of "subluxations", and also pointed out certain difficulties for chiropractors:
...the official definition of 739 codes is "nonallopathic lesions, not elsewhere classified.... In other words, 739 is a code that does not describe a subluxation. It does not even say what the patient has; it says that there is no code to describe what the patient has.... he elusive "vertebral subluxation complex" I learned about in school has no place in the ICD-9 code set. All we get is 739, which is a code for conditions that do not have a code.
ICD-9 has never provided a code that truly describes this and differentiates between the chiropractic subluxation and the allopathic subluxation. Chiropractors have been compelled to try to fit a square peg into a round hole for many years.
At the time of writing it was still uncertain which codes in the newer ICD-10 would be useful for chiropractors and how they would be interpreted.

Components

Traditionally there have been five components that form the chiropractic subluxation.
  1. Spinal Kinesiopathology
  2. Neuropathophysiology/Neuropathology
  3. Myopathology
  4. Histopathology
  5. Biochemical changes

    Diagnosis

Historically, the detection of spinal misalignment by the chiropractic profession has relied on X-ray findings and physical examination. At least two of the following four physical signs and/or symptoms must be documented to qualify for reimbursement :
  • Pain and tenderness
  • Asymmetry/misalignment
  • Range of motion abnormality
  • Tissue/tone changes

    Rationale

It has been proposed that a vertebral subluxation can negatively affect general health by altering the neurological communication between the brain, spinal cord and peripheral nervous system. Although individuals may not always be symptomatic, straight chiropractors believe that the presence of vertebral subluxation is in itself justification for correction via spinal adjustment.
V. Strang, D.C., describes several hypotheses on how a misaligned vertebra may cause interference to the nervous system in his book, Essential Principles of Chiropractic:
  • 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 occur.
  • 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 misalignment can cause the dentate ligaments to put a stress on the spinal cord.
  • Psychogenic hypothesis: emotions, such as stress, causing contraction in skeletal muscles.
The vertebral subluxation has been described as a syndrome with signs and symptoms which include: altered alignment; aberrant motion; palpable soft tissue changes; localized/referred pain; muscle contraction or imbalance; altered physiological function; reversible with adjustment/manipulation; focal tenderness.