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What is Subluxation? Maybe Not What You'd Think a Chiropractor Would Say

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What is a subluxation?

by William M. Thomas, D.C., QME



This article was written because of the incorrect assumptions of both critics and doctors of chiropractic who have not logically thought out their craft, what they do and why they do it and perpetuate the myths about chiropractors and chiropractic.  It is not about "nerve flow" or "nerve interference", but potentially more significant.


Subluxation Attacked


When you use the term “subluxation”, in any context, you must first define what you are talking about as this is a hotly debated term among chiropractors, and especially critics of chiropractors.  Most attacks against chiropractic do not apply to modern chiropractic practice, but admittedly still may apply to some chiropractors who still utilize old chiropractic theory and practice under such a paradigm. 


Definitions of Subluxation Misunderstood

1.  There is a medical term for subluxation, meaning a slightly dislocated joint.  A luxation is a dislocated joint, a subluxation is a slightly dislocated joint.  Chiropractors refer to this type of injury as a “medical subluxation” and not at all what most chiropractors are referring to. 


2.  There is a traditional/historical term and paradigm for subluxation, which is antiquated, but still used among chiropractors.  Basically this definition is a misaligned bone, putting pressure on a nerve, causing dysfunction.  Without the historical differentiation that the founding fathers theorized, we would not have arrived to where we are today.  Unfortunately, many chiropractors cling to this type of antiquated explanation of how chiropractic works, and although sincere in their beliefs, I believe they are sincerely wrong.  They are not wrong that chiropractic is effective and “works”, but in the mechanism and explanation of that mechanism that makes critics of chiropractors scoff, causing chiropractic to appear unscientific and mystical.  Many chiropractors are not aware that there is another way of describing a subluxation.  The marketing of chiropractic has not caught up to modern standards, as well as educational materials, and again, the paradigms of some chiropractors who still preach this form of “subluxation” doctrine.  Subluxation has historically been limited to the spine and spinal nerves, but not so among modern chiropractors. 


I use the term subluxation, but it is neither definition mentioned above. 


My View of Subluxation


Subluxation is synonymous with the term intersegmental dysfunction (osteopaths, or DO’s, call the same lesion a somatic dysfunction) that may result in a “subluxation” complex (multiple symptoms and/or dysfunctional changes), but must involve some level of dysfunction.  A subluxation is not actually a thing, but the lack of, namely, function.  The dysfunction may or may not produce pain, at least that is perceived by the patient, but still would cause the body to function sub-optimally.  Pain is what typically drives a patient to seek chiropractic care, however, discomfort is what typically prompts a patient that something is dysfunctional. 


What Happens to Subluxated Segments


This dysfunction complex--subluxation-- may include functional change (decreased range of motion, asymmetry, postural change, etc.), biomechanical change (gait, limping, favoring an injured area, etc.), biochemical change (inflammation, soreness, pain), neurological change (movement pattern change, ,proprioception/kinesthetics tingling, numbness, hypertonicity or hypotonicity and/or weakness). 


Untreated intersegmental dysfunction over time will likely result in physical/structural change, and based on the degree of dysfunction, will likely result in adaptation, arthritis or degeneration.  Segments that are most able to distribute the physical forces of the stresses being placed on the body will adapt the best, and degenerate the slowest.  Removal of the obstacles of normal segmental function (correction of subluxation) is the basis of modern chiropractic treatment.  Traditional/historical chiropractic has focused on nerve flow, admittedly, an unproven phenomenon, and subluxation the cause of disease (I do not follow this paradigm).  Modern chiropractic primarily focuses on neuromusculoskeletal issues, such as headaches, neck pain, shoulder pain, carpal tunnel syndrome, low back pain, sciatica, knee pain or foot pain by optimizing the body’s ability to maximally distribute the physical stresses placed upon them. 


Structural change may or may not be observed on an x-ray depending on the severity and length of time, as I believe that intersegmental dysfunction may present only as restriction, which may not show on a static x-ray, but may be view during fluoroscopy, postural analysis, or movement analysis.  In short, a “subluxation” may not always be viewed on an x-ray, as it may be a lack of movement, or restriction.


How Do Chiropractors Find Subluxations


Most chiropractors use a form of palpation to determine where an intersegmental dysfunction (subluxation) is, and is found to be the most reliable method of determination.  Typically it is tender to touch, stiff, possibly painful, or simply just “doesn’t feel right” to a patient.  A chiropractor can, after several years of palpation training determine what a normal motion of a joint feels like as well as abnormal.  Patients are usually able to verify that palpation of a particular segment or the surrounding tissue is tender, painful or stiff.  Medicare has requirements to document the “presence of a subluxation” called the PART process (P = Pain and Tenderness, A = Asymmetry/(misAlignment) R=Range of motion change, T = Tissue/Tone change).  Please see the American Chiropractic Association definition of Subluxation. 


Chiropractic Treatment of Subluxation and Its Mechanism


Most chiropractors practice a form of treatment to correct this type of dysfunction (Adjustment).  Some chiropractors are simply “subluxation removal specialists”, and typically follow traditional chiropractic theory.  I cannot stress highly enough that not all chiropractors are the same.  Many argue that the old paradigm is a simpler way to understand chiropractic, however, it is an incorrect explanation of the mechanism, based on what we now understand.  This is not to minimize the effectiveness of chiropractic at all.  Granted, regardless of the explanation or mechanism, chiropractic care will likely be effective, some techniques and doctors more than others.  If you believed you were putting grape soda at the pump in your car instead of gasoline, it wouldn’t matter what you believed, you would still be able to get from point A to point B. 


Note to Chiropractic Critics


Most chiropractic criticism attacks a “straw man” because it does not typically apply to modern chiropractic practice, and not all chiropractors, as not all practice traditional chiropractic.  Much of the criticism against chiropractic and chiropractors is valid, as some chiropractors continue to practice using an outdated paradigm; however, it cannot be directed against the entire profession.  Not all chiropractors are the same. 


Modern Chiropractic


Modern chiropractors will incorporate therapy, stretching, exercise, nutrition, order MRI’s, x-rays, EMG’s, or other diagnostic testing to ascertain a diagnosis.  Most modern chiropractors will adjust, or utilize an instrument, or table to aid in correcting subluxated segments. 


Traditional Chiropractic


Some chiropractors, particularly traditional chiropractors, may not diagnose at all, but will treat subluxation (I do not practice this way).  Purely subluxation based chiropractors do not treat symptoms, but only subluxation.  Symptoms usually resolve regardless based on the above mentioned mechanism.  Some chiropractors are philosophically opposed to therapy as they believe only the adjustment is necessary.  My belief is that it is adjunctive and complimentary to the adjustment and not necessary all the time, but is helpful to prepare a patient to be adjusted in most cases. 


For more information about chiropractic, please visit my website http://www.DrTChiro.com




Last updated 01/19/12


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