By Meridel I. Gatterman, MA, DC, MEd
The term subluxation has been used to describe the lesion treated by chiropractors since its inception. D.D. Palmer  described it in 1910 as "a partial or incomplete separation, one in which the articulating surfaces remain in partial contact." Because of confusion by other professions, some within the chiropractic profession would have us abandon the term.
Others have promoted a teaching paradigm: the vertebral subluxation complex (VSC), which has grouped various components in a model focused around the dynamic component of the subluxation. Based on the works of Homewood,  Janse,  and Faye,  this model began being taught at CMCC in the mid-1970s and was later popularizing through the Motion Palpation Institute.  Other authors have revised Faye's early model. The vertebral subluxation complex forms a paradigm for teaching the basic principles of chiropractic theory. By taking the VSC model one step further, the vertebral subluxation syndrome can be used to describe the primary clinical entity treated by chiropractors. [6-9]
Syndrome has been traditionally used to describe the aggregate of signs and symptoms associated with any morbid process and constituting together the picture of disease.  The focus for chiropractors today should not remain the terminology used to describe the vertebral subluxation syndrome, but rather the specific mechanisms whereby this complex aggregate of signs and symptoms is produced by altered spinal joint motion.
Recently, the primary fibromyalgia syndrome has replaced the controversial term fibrositis used to describe a condition that has been written off as psychological at best, with the physiological manifestations either denied or ignored.  When the multiple complaints and varied systemic complaints of this condition were recognized as a syndrome, objective investigation was fostered to the benefit of the many patients suffering from the condition.
Viewing the classic chiropractic subluxation in a similar manner would allow us to develop and objectively test the diagnostic features of the vertebral subluxation syndrome.
Table 1: Reported Diagnostic Features of the Vertebral Subluxation Syndrome
Feature Palmer 1 Homewood 2 Janse 3 Sandoz 12 Faye 14 Haldeman 15
Altered alignment X X X X X
Aberrant motion X X X X X X
Palpable changes X X X X X X
pain X X X X X X
function X X X X X X
manipulation X X X X X X
Focal tenderness X X X X X X
Identification of conditions resulting from vertebral subluxation then becomes the criteria for diagnostic indexing. Examples might include vertebral subluxation syndrome: headache; or vertebral subluxation: low back pain. The ultimate goal is directing the patient to appropriate therapy following identification of the vertebral subluxation syndrome.
1. Palmer DD: Textbook of the Science, Art, and Philosophy of Chiropractic. Portland, Portland Printing House, pp 490, 1910.
2. Homewood AE: The Neurodynamics of the Vertebral Subluxation, Ed. St. Petersburg, Fl., Vlkyrie Press, 1977.
3. Janse J: Principles and Practice of Chiropractic. Hildebrandt Ed. National College of Chiropractic, Lombard, Il. 1976.
4. Faye LJ: Lecture Notes, Motion Palpation, Canadian Memorial Chiropractic College, 1976.
5. Faye LJ: Motion Palpation of the Spine. Motion Palpation Institute, Huntington Beach, Ca., 1981.
6. Dishman R: Review of the literature supporting a scientific basis for the subluxation complex.
J Manipulative Physiol Ther. 1985 (Sep); 8 (3): 163-74
7. Dishman RW: Static and dynamic components of the chiropractic subluxation complex: a literature review.
J Manipulative Physiol Ther. 1988 (Apr); 11 (2): 98-107
8. Gatterman MI: Chiropractic Management of Spine Related Disorders. Williams & Wilkins, Baltimore Md., pp 40-49, 1990.
9. Lantz CA: The vertebral subluxation complex. ICA Int'l Rev of Chiropractic, pp 37-61, Sept/Oct, 1989.
10. Stedman's Medical Dictionary, 25th ed, Williams and Wilkins, Baltimore Md., pp 334, 1494, 1522. 1990.
11. Smythe H: Tender points: evolution of concepts of the fibrositis/fibromyalgia syndrome.
Am J Med. 1986 (Sep 29); 81 (3A) :2-6
12. Sandoz R: A Classification of Luxations, Subluxations, and Fixations of the Cervical Spine. Swiss Annals VI, 219-276, 1976.
13. Sandoz R: The natural history of a spinal degenerative lesion. Swiss Annals IX, 149-197, 1989.
14. Schafer RC, Faye LJ: Motion Palpation & Chiropractic Technique Principles of Dynamic Chiropractic, 2nd ed. MPI, Huntington Beach, Ca.
15. Haldeman S: Spinal manipulation therapy in the management of low back pain. In Finneson BE, Ed. Low Back Pain, 2nd ed. JB Lipincott, Toronto, 1973.
M.I. Gatterman, M.A., D.C.
Canadian Memorial Chiropractic College
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