Theories of Subluxation: An Introduction

1
Theories of Subluxation An Introduction

• Toward the development of an operational
  understanding
• of subluxation

2
References

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

3
Updated references

• Chapters 4-9, Fundamentals of Chiropractic, 2003,
  Redwood Cleveland
• (8, Neurobiologic Relations and Chiropractic
  Applications)

4
Also Recommended

• Chiropractic Secrets, 2000
• Gardner and Mosby
• (Chapters by several PCC faculty)
• (Good National Board Review)
• Its out of print, but copies still are around

5

• 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

6
Some proposed mechanisms

• theory author
• 1. Restore vertebrae to Galen (1958)
• normal position
• 2. Straighten the spine Pare (1958)
• 3. Restore blood flow Still (1899)
• 4. Relieve nerve Palmer (1910)
• compression

7
Some proposed mechanisms

• theory author
• 5. Relieve irritation of Kunert (1965)
• sympathetic chain
• 6. Mobilize fixated Gillet (1968)
• vertebral segments
• 7. Shift fragment of Cyriax (1975)
• IVD

8
Some proposed mechanisms

• theory author
• 8. Mobilize posterior Mennell (1960)
• joints (z-joints)
• 9. Remove interference DeJarnette (1967)
• with CSF circulation
• 10. Stretch contracted Perl (1975)
• muscles

9
Some proposed mechanisms

• theory author
• 11. Correct abnormal Homewood (1963)
• somatovisceral reflexes
• 12. Remove irritable Korr (1976)
• spinal lesions
• 13. stretch/tear adhesions Chrisman (1964)
• around nerve roots

10
Some proposed mechanisms

• theory author
• 14. Reduce distortions Farfan (1973)
• of the annulae (annulus
• fibrosus
• Neurobiologic Mechanisms of Manipulative Therapy,
  1978

11

• 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?)

12
Areas of Research Involved in Mechanism of Action
of Adjustments/Chiropractic Corrective Procedures
Adjustment/Corrective procedure
2
Change in the musculoskeletal system
1
3
Change in the nervous system
4
Change in organ dysfunction or tissue pathology
or symptom complex
13

• 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

14
Major Subluxation Theories (Dr. Charles
Henderson, PCC Researcher)

• IVF Encroachment
• Altered Sensory Input (dysafferentation)
• Spinal Cord distortion

15
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, Gattermans 1995 text
  Foundations of Chiropractic Subluxation

16
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)

17
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)

18
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

19
Psychosocial Assessment

• Mental attitude/outlook
• Social interactions
• Lifestyle habits
• Stress

20
Theories/Models of Subluxation

• Biomechanical
• Neurologic
• Trophic
• Psychosocial

21
Biomechanical Models of Subluxation

• Vertebral/spinal misalignment
• Abnormal motion fixation, hypermobility,
  compensation reaction
• Joint dysfunction progressing to spinal
  degeneration

22
Neurological Models

• Neurologic compression/traction/torsion
  affecting nerves, roots, cord
• Neurologic irritation
• Aberrant reflexes
• Deafferentation/dysafferentation
• Neurodystrophic/neuroimmune effects

23
Trophic Models

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

24
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)