What is a Chiropractic Subluxation?
Written by: James Demetrious, DC, DABCO – Board Certified Chiropractic Orthopedist
With overwhelming evidence that supports the inherent safety and efficacy of chiropractic care, doctors of chiropractic have a responsibility to convey to the world our unique means to alleviate suffering and improve the quality of life. How can we convey to others the empirical means and value of chiropractic care? How can we objectively measure, assess and codify our principal premise?
What if we Think About the Chiropractic Subluxation in a New Way?
The chiropractic subluxation can be regarded as a process of progressive neuromusculoskeletal cascade degradation. Theoretical physicists reflect upon biologic structural criticality with regard to interdependencies in given systems. Small events may precipitate larger events. The chiropractic subluxation can be defined as a spectrum disorder of interrelated neuromusculoskeletal clinical manifestations that include altered biomechanics, degenerative sequelae, and neurologic dysfunction.
We may consider that the chiropractic subluxation is a disorder or condition defined by and reflective of its many interdependent parts. Researchers have validated those components through objective means. Consider the following abnormalities and assessments that can be further tested pre- and post-chiropractic spinal adjustment:
- Disc Desiccation – Pfirrmann et al. provide us codification of IVD desiccation. Consider pre- and post-MRI assessment utilizing various chiropractic techniques in Pfirrmann 3 or 6 desiccation cohorts.
- Alteration of Endplate Diffusion – Substantive research has been dedicated to IVD endplate diffusion. Consider the measurements of diffusive and convective influx/efflux pre-and post-chiropractic care.
- Peri-Articular Edema/Modic Changes – Consider simple studies that could evaluate Modic 1, 2, and 3 changes pre- and post-chiropractic adjustment.
- Intra-Articular Synovitis – Mayo Clinic neuroradiologists Czervionke and Kotsenas describe the Fat-Saturated MRI sequences that improve the conspicuity of synovitis and periarticular edema. Consider measuring the clearance of periarticular edema with chiropractic adjustments and assessing chiropractic dosing utilizing pre-and post-MRI assessments.
- Segmental Mobility – Upright MRI scanners, fluoroscopy, and new digital x-ray systems that reduce radiation exposures can provide us substantial insight into intersegmental mobility pre-and post-chiropractic care.
- Paraspinal Muscular Atrophy – Elliott et al. provide insight into paraspinal muscle atrophy subsequent to trauma utilizing MRI. Consider visualizing those muscles pre-and post-chiropractic care. Consider means to measure the effect of atrophic changes on spindle cells and proprioception.
- Measurable Autonomic Responses – Simple assessments are available to assess autonomic function related to chiropractic care. Consider ECG assessments of cardiac arrhythmias, heart rate variability or the effect of chiropractic care in cases of notalgia paresthetica and brachial pruritus.
- CSF Pressure Gradients and Velocities – With burgeoning and noninvasive means to measure cranio-spinal CSF outflow and its effects on intracranial pressure in neurodegeneration, consider measuring those pressures and velocities pre- and post-chiropractic care.
- fMRI Assessments – Evaluation of the central nervous system has been performed pre-and post-chiropractic care by Harvard researchers and some of the best chiropractors in the world. They are defining the effect of spinal adjustments on the Salience system of the brain utilizing BOLD imaging. Consider expanding those studies to further evaluate the chiropractic premise.
- PET/SPECT – Remarkable papers have been published related to CNS metabolism. Shouldn’t we expand that data and further evaluate pre-and post-chiropractic adjustments?
- DTI/Tractography – Newly defined axonal flow is being assessed currently that will provide insight into neurologic abnormalities. Consider defining abnormalities of neurologic integrity and the effect that is measurable pre- and post-chiropractic adjustments.
The Chiropractic Subluxation
It is my opinion that the chiropractic subluxation is an aggregate of many testable interconnected constituents. It is a disorder that results in neuromusculoskeletal degradation. It is a predictable and variable response to genetic, acquired, and environmental micro- and macro-traumatic perturbations.
What is in a Name?
I don’t favor the terminology segmental dysfunction. I don’t think it adequately describes the cause, effect and beneficial outcomes of chiropractic care. For those doctors who favor the term segmental dysfunction, I submit the following:
- Consider ‘Janda Crossed Syndrome.’ Janda identified pieces and parts that are treated by others in different ways. I can choose to to describe it as Janda Crossed Syndrome or say the patient has inhibited deep flexors and facilitated pectoralis.
- Is it McKenzie extension or is it Cobra pose? Do physical therapists or yoga instructors care about different names despite differences or commonality? Is it dry needling or is it acupuncture? Is the reasoning the same? Is the approach different? Do their results differ?
- Consider any named medical diagnosis. Huntington’s disease has specific testable symptoms, signs and affect. As does Parkinson’s disease and MS. Each unique. Each are named for a spectrum of signs and symptoms.
Isn’t the chiropractic premise and approach unique and highly effective when subjected to comparative analysis with medicine, osteopathy and physical therapy? I submit that the chiropractic assessment and therapeutic approach are unique, qualified, and deserving of a proprietary designation.
The chiropractic profession is uniquely qualified to alleviate suffering and improve the quality of life of people throughout the world. The chiropractic subluxation is part of the historic lexicon of the chiropractic profession. With scientific advancement and insight, we can progress in a manner befitting a great profession. I submit that there is great utility in that which distinguishes us from others. For these reasons, I favor the term ‘Chiropractic Subluxation.’
With Respect to Those of Differing Opinions
My opinions are derived from my experience. I am a nationally distinguished, evidence-based board certified chiropractic orthopedist, author, and academic who can perform upper cervical adjustments utilizing a Palmer knee-chest table. I completed over 360 hours of rigorous post-graduate studies and successfully attained my diplomate status through difficult national examinations. I am also a classically trained chiropractor with over 36 years of active clinical experience.
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The views and opinions expressed in this presentation are solely those of the author. We offer this only to educate and inform.
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