Chiropractic Principles: Subluxations

The term subluxation was initially founded by the father of chiropractic D.D. Palmer who defined the word as being one or more misaligned vertebrae causing impingement of adjacent nerves (1). Palmer believed that this interfered with the function of the nerve, essentially leading to dysfunction or disease in the organs served by that nerve (1). Since Palmers time, and the adoption of the term subluxation, a popular debate has risen among the health professions, including chiropractors, to what truly encompasses the term subluxation.

An important issue with respect to the term subluxation is simply the way it is defined between health professions. As explained by Budgell (2), various health disciplines, such as medicine, nursing and chiropractic all have their own particular dialects when discussing certain terms. They attach their own special meanings to shared words. Therefore just like other health disciplines, chiropractic has its own unique language. When D.D. palmer coined the term subluxation, he described that it was the subluxation and nothing more that was the root of all dysfunction and disease (2). As understanding of the neuromuscluoskeletal structure and function advanced, modifications to this original theory were implemented. Chiropractors today have continuously updated their description of what truly defines a subluxation, however others feel as though the term should be replaced as it holds much burden (2).

Today with the help of research, the clinical model for subluxation and what it entails has been redefined in the chiropractic profession, although some individuals still believe strongly in the ‘Palmerian’ concept. Biomechanically when a tissue is injured, a deformation occurs that is inconsistent to the intended function (i.e. buckling), or tissue damage (1). Furthermore as discussed in the literature, it has been theorized that in fact a combination of biomechanical and clinical changes are occurring at the area of subluxation. Collectively, these changes have been referred to as the ‘subluxation complex’ (2). Researchers and chiropractors have grouped these changes into 5 main groups: kinesiopathology, myopathology, neuropathology, histopathology and pathophysiology (2). Kinesiopathology refers to the loss of normal vertebral positioning and motion in relation to neighbouring vertebrae. Myopathology refers directly to changes in the musculature in and around the spinal column. These changes may include pathological such as changes hypertonicity, spasming, and weakness. Neuropathology pertains to irritation or injury to spinal nerve roots through compression and/or stretch. Pathological changes that occur to the spinal tissues itself such as abnormal bony growths or degeneration of spinal discs is known as histopathology. The last change observed with subluxation involves the pathophysiology, which is described as biochemical changes in the spinal region. Such changes may include inflammation from injured tissues and accumulation of biochemical waste products (3). In collaboration, these changes induce a variety of responses in the body that can lead to a number of specific clinical cases or syndromes associated with the subluxation apart from those mentioned. For instance axoplasmic aberration may arise, affecting the axoplasmic transport as a result of spinal nerve root compression or irritation (3).

The spinal adjustment, or manipulation, has been a fundamental technique used to address subluxations within the chiropractic profession. Although the precise mechanism has not been identified for why manipulation tends to address the issue, a number of theories have been suggested. The first theory is that manipulation overcomes muscle spasm by resetting muscle spindles, ultimately relaxing the hypertonic musculature (4). Manipulation has also been shown to improve joint function and mobility by breaking scar tissue and increasing joint lubrication (4). It has also been shown that as a result of spinal manipulation, endorphins are released from the brain, ultimately suppressing the perception of pain experienced by the patient (4). Still today, some practitioners believe solely in the ‘Palmerian’ ideology of subluxation. They believe that an adjustment will move the vertebra solely so that it stops irritating the nerve (4). It is important to understand that all these potential mechanisms would interact with one another; therefore it is most likely a combination of these theories that allows spinal manipulation to be such an effective method of treatment.

References

1. Haldeman S. Principles and Practice of Chiropractic. United States of America: The McGraw-Hill Companies Inc.; 2005.

2. Budgell B. Subluxation. E-mail to Dr. Karin Hammerich (KHammerich@cmcc.ca) 2015 Nov [cited 2015 November 11].

3. Leach R. The Chiropractic Theories. United States of America: Wolters Kluwer health; 2003.

4. Ross K. The Chiropractic Theories: How does Spinal Manipulation Exert it’s Clinical Effect? [online lecture], Canadian Memorial Chiroporactic Collage; lecture given 2015 Nov 3.