Theories of Subluxation: An Introduction Toward the development of an operational understanding of subluxation

References:  Gatterman, Foundations of Chiropractic; Subluxation, 1995, Chapter 10 (R. Mootz, D.C.)  Korr, I.M., Neurobiologic Mechanisms of Manipulative Therapy, 1978

Updated references:  Chapters 4-9, Fundamentals of Chiropractic, 2003, Redwood & Cleveland (*8, “Neurobiologic Relations and Chiropractic Applications”)

Also Recommended:  Chiropractic Secrets, 2000 Gardner and Mosby (Chapters by several PCC faculty) (Good National Board Review) It’s out of print, but copies still are around

“Theoreticians of spinal manipulation, at one time or another, have implicated virtually every anatomical component of the vertebral motor unit in their attempts to explain the mode of action of their therapy.” Drum, 1975

Some proposed mechanisms: theoryauthor 1. Restore vertebrae to Galen (1958) normal position normal position 2. Straighten the spinePare (1958) 3. Restore blood flowStill (1899) 4. Relieve nerve Palmer (1910) compression compression

Some proposed mechanisms: theoryauthor 5. Relieve irritation of Kunert (1965) sympathetic chain sympathetic chain 6. Mobilize fixated Gillet (1968) vertebral segments vertebral segments 7. Shift fragment of Cyriax (1975) IVD IVD

Some proposed mechanisms: theoryauthor 8. Mobilize posterior Mennell (1960) joints (z-joints) joints (z-joints) 9. Remove interference DeJarnette (1967) with CSF circulation with CSF circulation 10. Stretch contracted Perl (1975) muscles muscles

Some proposed mechanisms: theoryauthor 11. Correct abnormal Homewood (1963) somatovisceral reflexes somatovisceral reflexes 12. Remove “irritable” Korr (1976) spinal lesions spinal lesions 13. stretch/tear adhesions Chrisman (1964) around nerve roots around nerve roots

Some proposed mechanisms: theoryauthor 14. Reduce distortions Farfan (1973) of the annulae (annulus of the annulae (annulus fibrosus fibrosus Neurobiologic Mechanisms of Manipulative Therapy, 1978

How do we develop an operational understanding of subluxation? (i.e.: What research needs to be done to fill in the pieces of the puzzle?)

Adjustment/Corrective procedure Change in the musculoskeletal system Change in the nervous system Change in organ dysfunction or tissue pathology or symptom complex Areas of Research Involved in Mechanism of Action of Adjustments/Chiropractic Corrective Procedures

“Little scientific information is currently available to resolve the questions of impact on human health that the FSL (functional spinal lesion) may have.” Triano, 1992

Major Subluxation Theories (Dr. Charles Henderson, PCC Researcher)  IVF Encroachment  Altered Sensory Input (dysafferentation)  Spinal Cord distortion

How do chiropractors evaluate individuals clinically to determine the appropriateness of chiropractic care?  Biomechanical evaluation  Neurologic evaluation  Trophic assessment  Psychosocial assessment From Mootz, Chapter 10, Gatterman’s 1995 text; Foundations of Chiropractic: Subluxation

Biomechanical Evaluation  Contributing mechanical etiologies: (trauma, repetitive postural activities, etc..)  Static asymmetries: (high shoulder, altered curves, rotated foot, etc…)  Dynamic asymmetries: (gait, other movements)  Passive and active individual joint ranges of motion: (static and motion palpation)  Imaging procedures used to evaluate the above (x-ray, static and stress views, videoflouroscopy)

Neurologic Evaluation  Symptoms (pain and its location and distribution- from patient history)  Palpatory tenderness  Altered muscle tone (palpation, EMG)  Vasomotor findings (thermography)  Sudomotor findings (palpation and galvanic skin response testing)

Trophic Assessment  Altered tissue texture  Edema (signs of inflammation)  Metabolic disturbances  Nutritional imbalances These may be signs of aberrant local tissue metabolism or vascularity; metabolic disturbances and nutritional factors may be causative or complicating factors in somatic disturbances, e.g… “pro- inflammatory state” These may be signs of aberrant local tissue metabolism or vascularity; metabolic disturbances and nutritional factors may be causative or complicating factors in somatic disturbances, e.g… “pro- inflammatory state”

Psychosocial Assessment  Mental attitude/outlook  Social interactions  Lifestyle habits  Stress

Theories/Models of Subluxation  Biomechanical  Neurologic  Trophic  Psychosocial

Biomechanical Models of Subluxation  Vertebral/spinal misalignment  Abnormal motion; fixation, hypermobility, compensation reaction  Joint dysfunction progressing to spinal degeneration

Neurological Models  Neurologic compression/traction/torsion; affecting nerves, roots, cord  Neurologic irritation  Aberrant reflexes  Deafferentation/dysafferentation  Neurodystrophic/neuroimmune effects

Trophic Models  Axoplasmic flow mechanisms  Vertebrobasilar arterial insufficiency  Neurologic ischemia, macro and micro  Lymphatic/venous stasis  CSF flow dynamics

Psychosocial Models  Psychogenic concepts: how mental/emotional state influences structure (a cause of VSC)  Somatopsychic concepts: how structure (VSC) influences mental/emotional states (effects of VSC)